By Jim McVeagh 01/11/2009

The Sunday Star Times makes the rather obvious connection between the spread of the Superbug ESBL and the lax hand-washing practices of staff, particularly doctors. I will be the first to admit that we doctors are a slack bunch in general when it comes to hand-washing.

“There are many excuses healthcare workers come up with for skipping hand hygiene,” says Roberts [SALLY ROBERTS is clinical head of microbiology at Auckland City Hospital]. They’re busy. Constant hand-washing irritates the skin. Some workers think changing gloves will be adequate (it isn’t, because microbes can penetrate the micro-holes). Or they simply don’t accept they have a role in transmitting infection.

It is my observation that the latter two reasons Roberts gives are uncommon. Most people wash their hands after using gloves, if only to reduce their likelihood of developing latex allergy or to remove the powder. And I’ve never met a single nurse or doctor who thinks that lack of hand-washing does not lead to transmission of infection. So it is the first two reasons are the predominant ones for poor hand-washing regimes. Which is why there is a simple solution.

Alcohol hand rubs.

They  are quick and easy to use and most contain emollients that keep the skin from cracking with multiple use. While not quite as good as a proper hand wash, they are far, far better than nothing at all. And many, if not most, hospitals now have this hand rub. However, staff are not used to it, so don’t use it. It should be reasonably simply to encourage staff to use the hand rub. You still need to wash your hands occasionally (the manufacturers say after 20 uses which translates to about once an hour for ICU staff and 3-4 times a day for GPs – much more manageable)

Interestingly, I have observed that it is the younger staff who do not wash their hands. I recall hand-washing regimes being drilled into me by fearsome senior nurses. I suspect these disciplines are not emphasized, perhaps not even taught, at medical school nowadays. Comments on this from current new graduates would be welcome.


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