Effect Measure

Hand sanitizer just right for doctors

I had to laugh when I saw FDA was warning consumers in Puerto Rico that some hand sanitizers had high levels of bacteria (Burkholderia cepacia) that can cause serious infections. It’s not really funny of course, except that one of the hand sanitizers was called ?MD Quality Hand Sanitizer? (the other one was “Bee-Shield Hand Sanitizer?). Most appropriate, considering that a persistent problem with hospital infections is that we doctors are insufficiently conscientious about washing our hands between patients, A study in 2004 showed that doctors washed their hands only about half the times when it was indicated. Five years later, things hadn’t improved:

Only one in four doctors wash their hands between patients on some wards within the McGill University Health Centre, an internal audit has found.

Nurses do a better job, but their rate of compliance is still 40 to 50 per cent – a factor that’s blamed for the spread of germs and deadly infections in hospitals.

What’s more, results from the audit taken last year show little progress since a study was conducted at the MUHC in 2001. That study found that fewer than one in four doctors and less than 40 per cent of nurses took hand-hygiene precautions. (The Gazette [Montreal])

A hundred years before I was born, Oliver Wendell Holmes, Sr. (father of the later Supreme Court Justice) observed that doctors were responsible for transmitting childbed fever (puerperal fever) from one pregnant woman to another. Since disease was caused by God and not God-fearing doctors, he his opinions weren’t looked upon kindly. A few years later Ignaz Semmelweiss noticed the vast difference in puerperal fever rates in two maternity wards at the Vienna Lying-In hospital, one staffed by midwives and one by medical students and supervising doctors. He blamed the difference on contagion from the autopsy room where students were dissecting bodies. Use of a strong antiseptic brought the rates in line. All this was before the germ theory of disease, and the cry, “Doctors wash your hands” was controversial if not heretical.

Now we know better. So when we don’t wash out hands, we are committing malpractice. Unless, of course, we are washing our hands with “MD Quality Hand Sanitizer.” Then we are just carrying on a grand old tradition.

Comments

  1. #1 drstu
    March 24, 2010

    While every doctor would agree that hand hygiene is an integral part of the practice, in the case of the Puerto Rico product, the issue at hand was related to the company’s manufacturing facility. The company cited specializes in making beverages, and according to FDA examiners, their facility failed to meet quality control requirements re: hand sanitizer products, and as a result, it was not a “clean” environment, which resulted in bacteria corrupting their hand sanitizer product. Stuff happens, and reminds us to be concerned on who is putting things into our hands..

  2. #2 Alex
    March 24, 2010

    “Only one in four doctors wash their hands between patients on some wards within the McGill University Health Centre, an internal audit has found. ”

    HOLY SHIT! Me and Alex go to McGill! This is outrageous! If I ever go to the HC, I’ll ask the doc to wash his hands in front of me so I can be certain not to get anything.

  3. #3 Alex
    March 25, 2010

    In the above, I meant me and Marc lol.

  4. #4 Rob Monkey
    March 25, 2010

    This is one of my personal pet peeves, the “hand sanitizer instead of hand washing” idea. Drstu is exactly right in saying that this is a problem with the manufacturer, and it’s really a good sign that the FDA is doing it’s job, but that sanitizer shit is not nearly as good as just good old soap and water, without destroying the dr’s natural flora. Killing off all the bacteria on your hands allows anything to flourish, whereas just washing your hands will allow the natural bacteria to cover your hands, denying harmful bacteria a foothold on your skin. But hey, that would get in the way of the good ol’ American traditions of being afraid of every goddamn thing you can’t see, and solving said problem via scorched-earth policies ;)

  5. #5 revere
    March 25, 2010

    Rob: This is an important point, but pet peeve or not, requires better evidence than I think exists. Detergents and soaps are very effective germicides but it is not clear to me they are more forgiving of normal flora and hard on pathogens compared to hand sanitizers. You can find a lot of bacteria in the soap dispensers of a public bathroom. So you raise an important question but I don’t think it is yet answered.

  6. #6 Karen
    March 27, 2010

    I’m surprised others haven’t noted Ignaz Semmelweiss’s role in this controversy, which started in Austria just one year after Holmes’ observation. Semmelweiss was able to observe a difference in rates of this devestating disease among those who were tended by nurses and those cared for by physicians, who did not wash after attending their autopsy lessons. Needless to say, this disparity appears to continue today, with nurses more likely to wash than physicians. I like this approach to verification of hand-washing – http://www.rfidjournal.com/article/print/5142 . Here’s another story of monitoring hand-washing…has it come to this? http://ohmygov.com/blogs/general_news/archive/2009/11/10/State-to-spy-on-doctors-handwashing-habits.aspx