Like Mom Always Said…
A few days ago, the CDC announced that 14,000 people die from Clostridium difficile (C. difficile) each year. This is a bacterium that lives in your colon, causing inflammation, diarrhea, and nausea. You might be thinking, so what? The problem is that many of these deaths could be prevented by proper hand-washing, because guess how you transmit bacteria from your colon to other people? The number of deaths is shocking to me when I think that half of those cases were acquired in hospitals because of improper hand-washing by the staff (and this is one of many other hospital-borne infections that can also do harm, like staph infections).
Other than what you may have thought as a child, your mother did not make up the idea that washing your hands is good for you. The first person to recognize that hand-washing can prevent disease was Hungarian Dr. Ignaz Semmelweiss around 1847. He worked at Vienna General Hospital, which had two maternity clinics. One was assisted by doctors and medical students and the other by midwives. He observed that ~13% of the mothers at the obstetrics clinic died from ‘childbed fever’, while only 2% of the mothers died while in the care of the midwives. Semmelweiss realized that doctors and medical students were dissecting cadavers for their autopsy or study and ‘invisible cadaver particles’ were being transferred to the new mothers. Thus began the era of germ theory of disease, even though the microorganisms that caused these diseases were unknown at the time. He instituted the regimen of washing hands and instruments in a chlorinated lime solution and ‘childbed fever’ was nearly eradicated.
A recent Freakonomics podcast described hand-washing practices at Cedars-Sinai Medical Center and tried to relate compliance to fiscal responsibility. I won’t get into how you can save more money here, but the story about hand washing at a major U.S. hospital can be a lesson for all. The hospital wanted to determine if they were doing all they could to prevent spread of infection. They asked the doctors to self-report hand-washing, and 73% claimed they were washing their hands as they should. However, during the same period, the nurses were ‘keeping an eye’ on the doctors and reported that only 9% of the doctors were in fact washing their hands between patients. NINE PERCENT. The most educated, supposedly responsible people at the hospital had the worst hygienic behavior compared to 65% of all hospital workers, including the custodial staff, who were washing their hands properly.
The best part of this story is how they got these doctors to change their behavior. Education through signs, emails, and rewards didn’t work, but showing them exactly what was on their hands did. Each person pressed their hand into a petri dish of agar, which was cultured for a couple of days, and then they actually SAW the bacterial colonies growing in clumps in the shape of their hand. The hospital took a picture of the worst one and made it the screensaver to every computer in the hospital. Now people were washing their hands – 100% of the time. Yet, it’s human nature to become desensitized to things like this over time, and people fell back into their old habits. The best way to get doctors to wash their hands? Announcing the names of those that failed the hand-washing tests (using the agar plates) at departmental meetings and shaming them into doing a better job.
Human behavior is hard to change, no matter who you might be. If we want to prevent spread of diseases everywhere, not just in the hospital, the take-home message is: wash your own hands early and often – and don’t be afraid to ask your doctor to do the same.