WASHINGTON, Dec. 21 (UPI) -- For more than 150 years, doctors have known that washing their hands before seeing a patient can be life-saving.
Yet, today, getting hospital staff to wash their hands with soap and water or use an antiseptic alcohol rub before moving from one patient to another continues to be a problem worldwide in health institutions.
Thus, hospitals have come up with a variety of solutions to revive a seemingly lost art but critical bacteria-busting practice, which health experts even say is one of the best defenses in the event of a bird-flu pandemic.
Healthcare facilities are employing everything from employee hand checks to placing antiseptic alcohol rubs at hospital bed rails where doctors and other hospital workers can't miss them.
For example, in Beersheva, Israel, doctors acted decisively after an in-hospital outbreak of diseases caused by the drug-resistant fungus Candida parapsilosis and the bacterium Acinetobacter baumannii. Infection-control officers took hand cultures weekly from staff personnel until the outbreak was controlled.
"Why don't people do what they are told to do?" grumbled Kerstin Mannerquist, an infection-control nurse at the Swedish Institute for Infectious Diseases Control, Solna.
"Why don't they rub their hands before and after patient contact when they know it is so important? We have only known it since 1847."
That's the year that Viennese physician Ignaz Semmelweis discovered that he could reduce mortality of his patients from infections by washing his hands before attending to them. The practice of scrubbing before surgery and washing before seeing patients became routine -- or should have.
In Beersheva, Abraham Borer, head of the infection-control unit at Soroka University Medical Center, said, "Despite compelling evidence that proper hand washing can reduce the transmission of pathogens to patients and reduce the spread of antimicrobial resistance, the adherence of health care workers to recommended hand-hygiene practices has remained unacceptably low."
Borer set in practice the weekly culturing of the hands of staff and patients in an attempt to raise consciousness of the problem and to try to get a conscientious approach to hand-washing.
His first look at the cultures was shocking. In September 2004 about 46 percent of patients and 55 percent of staff tested positive for Candida or Acinetobacter. In addition, about 12.9 percent of patients in the hospital had bloodstream infections caused by those microbes.
But after announcing those results and implementing the weekly tests, the changes were dramatic. In October 2004 about 12.5 percent of patients had bacteria colonization; 14.5 percent of staff was still positive for the organisms; but bloodstream infections were constant at 12.5 percent.
A month later, and continuing through March 2005, patient colonization fell to 5 percent, as did staff colonization, and no bloodstream infections were seen.
Borer's report and several others were featured at this week's Interscience Conference on Antimicrobial Agents and Chemotherapy, sponsored by the American Society for Microbiology. The theme of hand-washing to reduce infection had been promoted by the ASM for more than a decade, but the number of reports presented at the conference on the need to improve in-hospital hygiene through hand-washing illustrated that it isn't an easy thing to accomplish.
Borer suggested that having to culture everyone's hands to get across the hygiene measure has its own difficulties in time and effort, but the "super-bugs" plaguing his hospital did vanish.
"Proper hand washing and hygiene continues to be a universal problem," Jacob Gilad, an infectious-diseases investigator and co-author of the report from Soroka University Medical Center, told United Press International.
Another effective way to get people to perform better hand hygiene in the hospital setting is to make sure that the alcohol gels are more easily accessible, he said.
Helen Giamarellou, professor of infectious diseases at ATTIKON University General Hospital, Athens, Greece, said she did her own hygiene experiment by placing alcohol rub cleansers on the bed rail of the patients -- giving healthcare workers, including doctors, less of an excuse for not being able to quickly and rapidly find the container.
Her study found that 80 percent of doctors used the bed-rail antiseptic system, while only 7 percent of doctors in another ward used a wall mounted dispenser. She noted that when a bed-rail system was installed in the second ward, observers noted a rapid increase in its use by the medical staff.
In Sweden, Mannerquist told hospital staff that researchers would be monitoring hand hygiene by measuring levels of alcohol rub used in different wards.
Her findings: In the intensive care unit almost three times as much of the cleanser was used when compared to the surgery unit and about 20 percent more than was used in the medical units.
But even in the critical care units, the cleansers were used only about 50 percent of the time when they should have been used -- and that was the best performance. Mannerquist said that by announcing the results it might encourage better compliance with the procedure.
Researchers found that work load and religious beliefs can also interfere with proper hand hygiene. Stijn Blot, an infection-control specialist at Ghent University Hospital in Belgium, said his study found that when nurses believe their workload is too high, they tend to be neglectful in proper hand hygiene.
Dr. Ziad Memish, consultant in internal medicine and infectious diseases at the Saudi Arabian National Guard Health Affairs hospital in Riyadh, said some healthcare workers who are Muslims have avoided using the alcohol rubs because of concerns that use of alcohol products violates Islamic prohibitions against alcohol.
However, Memish noted that those objections come mainly from Muslims in Western Europe. "At the King Abdul Aziz Medical Center in Riyadh, where most health care workers and almost all the patients are Muslim, alcohol-containing hand hygiene cleansers have been the standard of care for a number of years without encountering any resistance to their introduction," he said.
Memish suggested that Muslims who are wary of alcohol for hand cleaning may not be aware of the Koran commentary that use of alcohol for medicinal purposes -- such as hand hygiene -- is permissible.
Whatever the cause of lack of efficient hand hygiene, "treatment of hundreds of millions of patients worldwide is complicated by infections acquired during health care," said Dr. Benedetta Allegranzi, assistant professor of infectious disease at the University of Verona, Italy.
"To what extent inherent behavior shaped on cultural, religious and educational factors actually influences elective healthcare worker's behavior towards hand hygiene during health care requires further investigation," Allegranzi said.
