Wash your hands, please!

In 1845, Dr Semmelweiss in Austria investigated why women were dying of postpartum infections at an alarming rate, ~15%.  He instituted a policy of handwashing after discovering that interns and residents were sometimes proceeding straight from performing autopsies to delivering babies. After instituting the hand washing policy the rate of infection fell to the baseline for the era. Slowly his discovery that hand washing was an important tool to prevent spread of infections gained support.  It is now accepted as gospel truth that dirty hands can spread infection and that hand washing, as simple as it may sound, is one of (if not the) most important weapon against preventing the spread of nosocomial infections.

When I was in Mongolia, I was aghast at the lack of facilities for appropriate hand hygeine.  The staff restrooms often doubled as storage closets.  There was no way to dry your hands.  They did have alcohol gel avialable to use before touching patients, but not at every bedside to be sure.  When the neonatologist there broached the subject of their infection rate, Monica and I immediately launched into a discussion of careful attention to hand hygeine and appropriate patient skin prep and care of central lines.  At first they were resistent, but with gentle support they could appreciate the impact something so simple could have.  Of course, the barriers to hand hygeine in an emerging country are huge.

However, it would be very narcissistic and first world-centric of me to say that the barriers only exist in such circumstances as those I saw in Mongolia, when everyday in my unit we are still working to achieve 100% compliance of all health care practitioners to hand hygeine.  For something so fundamental, I do not think that 100% compliance is an unrealistic goal and fortunately, I have the support of my hospital to try to get there.

Thanks Dr. Semmelweis.  I hope your contributions to medicine will no longer have to be talked about soon.