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Wednesday, January 30, 2008

Infection Control Nightmare Decades Old, No Sign of Remission

The issue of over use of antibiotics leading the charge toward higher infection rates in hospital and community has been heartily debated for decades. While there seems to be no end in sight, especially prescribing antibiotics for almost every ill in a time when many antibiotics fail, this study does suggest some helpful methods.

Handwashing is without a doubt one of the best methods for preventing cross contamination. Gels, however, do contain a high alcohol content which is drying to the skin. Unlubricated dry skin leads to cracks in the skin and an opportunity for bacteria to pierce this protective layer. Many commercial products used for moisturizing skin contain harmful chemicals that ultimately fail to keep the skin well lubricated. This group includes many so called natural products sold in health stores.

Trimmed nails are an issue too. One Spokane hospital established this rule several years ago. When I worked in ICU we had nail brushes provided along with the soap, mostly iodine based products were popular at that time.

Cell phones do attract bacteria because of the ionizing effect of EMF/ELF.

Cleaning methods are also a factor, as are the old standards in chemically based cleaning.

I believe the housekeeping component is an area needing to be addressed.

There are in fact excellent cleaning products available that are not chemically based. These products have shown effectiveness in reducing infection rates and preventing reinfection.

And of course there is the scientifically based utilization of pure therapeutic essential oils which do not become resistant to bacteria.

I am still waiting for the day when I receive more than one or two inquires about my protocols using these protective oils.

Hand gels alone may not curb infections
By TIMBERLY ROSS, Associated Press Writer
Wed Jan 30, 2008

Doctors and nurses on the go often skip soap and water in favor of an alcohol-based hand gel, thinking the quick-acting goo will kill bacteria on their hands and curb the spread of infection. It turns out that's not enough.

In a Nebraska hospital, medical workers nearly doubled their use of the alcohol-based gel, but their generally cleaner hands had no bearing on the rate of infections among patients.

The doctor who studied the problem pointed to many villains: Rings and fingernails that are too long and hard to clean, poor handling of catheters and treatment areas that aren't sanitized.

"Hand hygiene is still important, but it's not a panacea," said Dr. Mark Rupp, an infectious disease specialist at the University of Nebraska Medical Center. He led the study at the adjoining Nebraska Medical Center.

The results of his study appear to contradict hospital guidelines from the Centers for Disease Control and Prevention that say better hand hygiene — through frequent washing or use of hand gels — has been shown to cut the spread of hospital infections.

The spread of infection-causing germs in U.S. hospitals is a huge health problem, accounting for an estimated 1.7 million infections and 99,000 deaths each year, according to the CDC. These include drug-resistant staph, urinary tract infections and ventilator-associated pneumonia, among others.

"There are many factors that influence the development of hospital-acquired infections. It would be naive to think that a single, simple intervention would fix this problem," Rupp said.

His study appears in the January issue of Infection Control and Hospital Epidemiology.

Research has shown alcohol-based hand gels are more effective, faster and easier to use than soap and water. The findings of the new study were based on 300 hours of hand hygiene observations of nurses and doctors in two comparable intensive care units over a two-year period.

More gel dispensers were put in the units, and usage rose from 37 percent to 68 percent in one unit and from 38 percent to 69 percent in the other. Compliance for hand washing of any kind in most hospitals is estimated to be about 40 percent, according to experts, although some hospitals do better.

Every two months, bacteria samples were taken from health workers' hands, which were found to be cleaner when using the alcohol gel.

The infection rates in both ICUs were "relatively low," the study said. And researchers found "no significant relationship" between rates of hand gel use and infections among patients. In fact, in one unit the infection rate rose when the hand gel was widely available and its use promoted.

Rupp found the results surprising. However, he said hospital-borne infections cannot be stopped by better hand hygiene alone because infections aren't limited to person-to-person contact.

He suggested hand gels be combined with other measures, such as better cleaning of hospital units, proper insertion and maintenance of catheters, and doctors prescribing antibiotics only when necessary so more drug-resistant bacteria don't pop up.

He also said hospital workers shouldn't wear rings and should trim their fingernails even more than the CDC recommendation of no longer than a quarter of an inch. Rupp said bacteria showed up when nails extended just beyond the fingertip.

Mike Bell, who deals with infection control at the CDC, said that while he didn't agree that hand gels do little to reduce infection, Rupp was right to say they were just one part of the solution.

"If they don't do everything else right, having clean hands is not enough," he said.

Both Bell and Dr. David Hooper of Massachusetts General Hospital in Boston suggested that Rupp's study would have shown a reduction in infections if it was conducted over a longer period.

Hooper said the compliance rate for hand hygiene at Massachusetts General has been about 90 percent for the past several years. The number of drug-resistant staph cases was cut in half and continues to decline, he said.

On the Net:

University of Nebraska Medical Center:

Centers for Disease Control and Prevention:

Massachusetts General Hospital:

Copyright © 2008 The Associated Press.

1 comment:

Anonymous said...

I stopped for cofee a a local convenience shop yesterday and noticed the cashier had a button on her lapel that read "if i do not give you a receipt your purchase is free". Ovbiously the management is trying to drive behavior by making the clerk accountable for his/her actions as reinbursement for the mistake will probably come out the clerks pocket.

What does this have to do with infection control in a hospital setting? If it is good enough for a convenience store why can't it be used when lives are at stake ? Millions and millions are spend on education, information systems, dispensers, etc, etc. We do very little to establish controls that provide feedback regarding how well hospital employess are complying with the hand washing rules.
What if hospitals employess wore a button that said "If I do not wash my hands prior to touching you then your hospital stay is free"
That would send the message that the hospital is very serious about infection control.
The question is are there any hospital administrators out there that would put their money were their mouth is?