By Faith Robertson
If you were to take a stroll through the hospital, you would witness scrub-adorned healthcare providers, a flurry of white coats and stethoscopes, and a plethora of wall-mounted hand sanitizer dispensers.
No patients come to the hospital with the intent of acquiring an illness.Yet approximately 1 in 25 patients develops at least one healthcare-associated infection during their visit. Unfortunately, the hands that are meant cure are often the culprits. For example, during early morning rounds, a team of residents, medical students, nurses, PAs, and maybe an attending or two, will see upwards of 20 patients in an hour. There are countless handshake introductions, laying of hands for bedside exams, incision inspections, staple removals, and more. The skin-to-skin contact between patients and care teams as they move from room-to-room has been linked to numerous outbreaks of MRSA, VRE, and other infectious pathogens. However, doctors and nurses use of alcohol-based handrub has been shown to reduce hand bacteria by 95-99%. Consequently, hospital protocols and the Joint Commission require healthcare workers to use an alcohol-based handrub, and/or wash hands with soap and water, both before and after contact with a patient or a patient’s environment. Seems simple, right?
Actually, while the adherence rates have increased over time with the help of publicity, strategic goals, rewards, and special incentives,barriers to complying with proper hand hygiene remain. Publically available data from Massachusetts General Hospital, where I’m presently working, shows that >90% of healthcare providers and volunteers comply with proper hand hygiene after patient interaction , fewer individuals consistently clean their hands prior to patient contact (data from 2009-2015).
For surgeons, there is even greater need to respect the dangerous potential of germs, dating back to Joseph Lister’s theory in 1867 that germs led to surgical site infections. Surgeons have an additional responsibility to follow sterile hand techniques prior to every procedure. Even before we glove in preparation for our incision, we keep our nails to <1/4 inch in length, ensure our polish is not chipped, remove our rings, and chose between chlorhexidine gluconate, iodophor, or para-chlorometaxylenol (PMCX) scrub brush packages, or a “dry” foam scrub (which may be more effective, according to a 2015 study in the Journal of Microbiology, Immunology and Infection). We stand at the sink, running a song in our heads, or anticipating steps of the upcoming surgery while meticulously completing the ritual, a symbol of our dedication to protect the patient from harm. We scrub as our mentors taught us, and we set examples for those who look up to us.
Though, there may be a downside to this excessive cleaning. In September 2016, Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research said: “In fact, some data suggests that antibacterial ingredients may do more harm than good over the long-term.” Multiple antibacterial production companies did not provide sufficient data for the safety of all ingredients in their products. The FDA has brought this concern to light and is mandating that many companies to accrue data on the safety and efficacy of these cleaning products in the next year. Three of the ingredients under scrutiny are benzalkonium chloride, benzethonium chloride, PCMX (listed above as one of the surgical scrub agents). The products will remain on the market until next year’s review and forthcoming data will clarify any risks of antibacterial agents.
Overall, hospital-acquired infections can greatly impact our patients, and we have a role as providers to maintain good hygiene practices and positively impact the culture of hygiene within the hospital. How are you doing? Are you above the 90% national benchmark for hand hygiene? If not, what is the barrier? Whether you were rushed between patients and omitted that sanitizing pump between rooms, or your hands are sensitive to the alcohol-based handwash so you lather less, I encourage you to extend a helping hand that is 95-99% more pathogen free.
Faith Robertson is a 3rd year student at Harvard Medical School and is the Vice Chair of the AWS National Medical Student Committee. She plans to pursue a Master of Public Health next year, before applying into neurosurgery with aspirations to continue global surgery work throughout her career.
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