The Achilles hand of infection prevention

January 12th, 2015

It seems only appropriate to begin HICprevent – Hospital Infection Control & Prevention’s new blog site – with a message near and dear to our hearts and hands. This Aug. 13th will mark 146 years since Ignaz Semmelweis – the Hungarian physician who was widely discredited by the medical community for rather tenaciously observing that hand washing prevents infections – died in an insane asylum in Vienna. This was after psychiatric “treatments” that reportedly included repeated cold water dousing and laxatives. And we think we’ve had rough career paths! Semmelweis was later vindicated, of course, but infection preventionists attempting to reaffirm his hand hygiene message have been flirting with madness ever since. Historically speaking, the odds of a health care worker having washed their hands before touching a patient have been roughly equivalent to a coin flip. Heads the patient wins, tails they could be joining the 100,000 souls lost every year to healthcare-associated infections (HAIs).

Today there is much talk of revolutionary checklists, public transparency, patient empowerment and various and sundry other things in a new era of infection prevention. But let me ask you this: If that is your child – grandmother, loved one – in the hospital bed the night-shift nurse is approaching, how comfortable are you that those hands touching the IV line were washed? Of course, knowing some patient on the same ward likely has MRSA or that C. diff eats alcohol hand rubs for breakfast doesn’t exactly ease the head toward the pillow. No, if you are like me, you’re going to want to be there – hectoring all who dare enter to wash hands or be gone. This is the problem; it has always been the problem. When I began covering this field – with its recurrent outbreaks and cautionary tales – Ronald Reagan was president and a dedicated cadre of infection control “practitioners” were trying to get health care workers to wash their hands. The band, has indeed, played on. Is the glass half full or half empty? Will poor compliance always be the Achilles hand of infection prevention? Heads or tails? Call it in the air.