I like to say that "back in the day" when I was a pediatric nurse things were different. We sanded floors, filled patients' water pitchers, and gave back rubs; well, okay - we did two of three of them.
Back then hospital bugs were bad. Today they are bigger and badder. Still, some things remain the same. One of those is the very same thing parents and teachers taught you and, I imagine, you teach your children: wash your hands. Wash your hands after using the bathroom, before eating meals, and certainly between each patient.
In her NYTimes column on April 13, 2011, "Giving Doctors Orders", Maureen Dowd brings us into the ICU where her brother died after being admitted for pneumonia. For those of you who follow Dowd's work you know she is no shrinking violet. If anyone I would expect Dowd to stand up to the folks in the white coats and uniforms. And yet she writes, "I saw infractions of the rules in the I.C.U. where Michael died, but I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses and orderlies, irrationally hoping that they’d treat my brother better if they liked us."
Today Dowd would have the patient, the patient's family, and the loved ones in the room call out the healthcare practitioner - M.D. or not - to remind her: wash your hands before touching this patient.
Do you believe a healthcare professional would give you a hard time about that? Apparently so. Here's a script you can use:
"I called Cohen [CNN’s senior medical correspondent, Elizabeth Cohen], the author of “The Empowered Patient,” to ask her the best way to confront those taking care of you or family members. She said that you have to get over the “waiter spitting in your soup scenario,” that the medical professionals will somehow avenge themselves, by giving less attention, if you insult them.
“There are all sorts of reasons we default to being quiet,” she said. “It is general etiquette not to correct another adult, especially when this is their profession. But when the consequences are so grave, you have to summon up your courage.” You could say that you are a germaphobe, she suggested, and ask if they could please just indulge you?"
Even someone as well-versed in the critical role hand-washing plays in reducing hospital infections, Dr. Peter Pronovost, M.D., admits to being reluctant to stand up to one of his own:
"Dr. Peter Pronovost of Johns Hopkins has been able to prove in a national program that you can curb infections and reduce mortality rates in I.C.U.’s by adhering to checklists, creating accountability and fostering a culture where patients, their families and even nurses and residents feel freer to challenge doctors.
“There’s no doubt that it’s really difficult to question physicians,” Dr. Pronovost says. “It’s hard even for me when my wife or my kids are ill. Many clinicians aren’t the most welcoming. They give verbal or nonverbal clues to say, ‘Hey, I have the answer.’ We just need to change the culture. The patient really is the North Star.”"
A few years ago I was responsible for researching, writing and developing a brand new website for a friend and client, Connecticut medical malpractice attorney, Vincent DeAngelo. DeAngelo wanted to provide a teaching website that focused on five critical areas that give rise to many medical malpractice claims: VBAC procedures, Hospital Infections, Medication Errors, Emergency Rooms, and Nursing Homes.
As you can see when you visit the link on Hospital Infections, DeAngelo was already instructing hospital patients and families to wash their own hands and ensure that healthcare personnel did as well.
In a way it's still a surprise that "everything old is new again." A recent study of 153 Veterans Affairs hospitals nationwide found a 62 percent drop in the rate of infections caused by MRSA (methicillin-resistant Staphylococcus aureus), "Study Finds Drop in Deadly V.A. Hospital Infections." Excerpt.
"The Veterans Affairs strategy employs a “bundle” of measures that include screening all patients with nasal swabs, isolating those who test positive for MRSA, requiring that staff treating those patients wear gloves and gowns and take other contact precautions and encouraging rigorous hand washing. The results may not be easily replicated in the private sector, but they are likely to step up pressure by further undercutting the notion, prevalent at many hospitals not long ago, that infections are an unavoidable cost of doing business." [Emphasis added.]
Whether or not the same results can be replicated in private hospitals - especially in this day and age of cuts, cuts and did I say cuts? - notice that hand-washing is still part of the mix.
Matters in hospitals are improving. This is a good thing. This is not enough:
"But the Centers for Disease Control and Prevention in Atlanta still estimates that one of every 20 patients will acquire an infection while hospitalized. Using data from 2002, the agency concluded that hospital infections were associated with 99,000 deaths and costs of $28 billion to $34 billion a year."