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Wednesday, September 5, 2012

Wash, Wash, and Wash Again

By Heather Millar

Doctor Washing Hands

“A hospital is no place to get well.”

If only that were just a well-travelled joke…every year more than 2 million people contract an infection while in the hospital. That’s nearly 1 patient out of every 20. Approximately 100,000 people die from these infections, making them the fourth leading cause of death in the nation.

Why is this so? The vast majority of the time it’s because a nurse, a medical tech, or a doctor has failed to wash their hands when moving from one patient to the next. Reams have been written on the importance of hand-washing in clinical care. You can’t walk 10 yards in a hospital without passing a hand sanitizer dispenser. Yet it’s still rare for a hospital to get 50 percent of their employees to comply with hand-washing rules.

This should be the number one tip in any cancer patient handbook: Always, always watch to see if the person approaching your hospital bed or your infusion chair washes their hands first! If they don’t wash, insist that they do before they touch you.

For cancer patients, the dangers go beyond just dirty hands while drawing blood, or changing a dressing or giving an injection. Many cancer patients have “central lines,” catheters inserted into a vein in the neck, chest, or groin. Central lines make it easier to draw blood and to give fluids or medications. They also eliminate the need for endless needle sticks.

Yet these devices—accessed as many at 30 times a day—also can provide a super-highway for bloodstream infections. In cancer patients these infections can be lethal. Each year, 250,000 central line infections occur in the United States, up to one-fourth of them fatal, according to the Centers for Disease Control and Prevention. Each infection carries a price tag of up to $25,000.

In a study just published on-line in the journal Pediatrics, a team at Johns Hopkins Children’s Center reports that following a basic set of precautions can dramatically reduce central line infections in the most vulnerable patients: children receiving chemotherapy or bone marrow transplants.

The team at Johns Hopkins introduced a rigorous protocol for central lines at the university’s pediatric inpatient cancer unit. This included:

• Washing hands before and after handling the line.

• Frequent and regular changing of the dressing covering the line.

• Regular changing of the caps and tubes attached to the central line.

• Cleaning of the line before and after each use.

• Wearing gloves and a facial mask when handling the line.

The team also gave parents wallet flash cards outlining the “do’s” and “don’ts” of central line care. They encouraged parents to be a second set of eyes, making sure that staff followed the protocols. Oncology nurses held monthly meetings to discuss every infection that occurred during the study.

In the first year of the program, the infection rate remained unchanged. But in the second year, the number of infections plummeted by 64 percent. Averaged over two years, the new approach prevented one out of five infections.

I can understand why it’s so difficult for hospitals to get staff to always, always observe strict protocols like these. It’s tedious to wash your hands again, and again, and then again, day after day. People get tired; attention wanders. Occasionally, they forget one or two steps in a procedure. But hand-washing, clean dressings, cleared lines and the like are matters of life and death. And it’s up to us patients to help our medical team to remember that.

Have you ever had to remind a nurse or a doctor to wash their hands? How did they react? Have you ever gotten an infection in the hospital? How do you think it might have been prevented?

Photo: Digital Vision

Posted by: Brianne Moore at 1:00 am

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