\"Easier said than done\"
By Dr Kadiyali M Srivatsa
Heath authorities and Health Protection Agency (UK) are yet again wasting time and money talking
about washing hand as the only solution to end the crisis of spreading hospital infection.
Biocides (disinfectants and antiseptics), are universally used in
hospitals to clean surfaces, sterilise medical instruments, wash
hands and equipment, and de-contaminate skin before surgery. At
the right levels, the chemicals destroy most microorganisms but if
weak doses are used the bugs can survive and grow stronger (1).
Bacterial count is said to increase when you wash hands more than
ten times every day. Hand washing has now been linked to
dermatitis, increased bacterial count in hands and colonization of antibiotic resistance developing in
the hands of healthcare workers. Study found that dry nurses' hands were twice as likely to be
colonized by bacteria. Some bacteria with a genetic pre-disposition to resistance to antibiotic
properties will survive. When these resistant bacteria divide, they pass their resistance on, creating
entire colonies of antibiotic-resistant bacteria colonized in the healthcare worker’s hands (2). Using
alcohol gel is not the answer because the low concentration kills good bacteria and help resistant once
to grow stronger.
Washing hands using soap & water for thirty seconds to one minute
(duration - singing happy birthday song help) is important. Observation of
\"Drying Time\" before injecting a needle through skin, is not well publicised
in UK (2).
Most healthcare workers forget the gloves will be contaminated if they
touch any part of patient’s skin. Vigorously rubbing swab on the skin and
then touching this sterilised skin-using index finger to palpate a vein can
make the area un-sterile (3). Although aseptic technique is critical to
reduce spreading infections (4), it is infrequently taught and audited. Skin
cleaning is often incomplete, & many attendants still palpate with non-
sterile gloves the venipuncture site before needle insertion. 58% of
healthcare workers are said to be colonized with MRSA. (5)
Swine flu is likely to bring medical profession down on our knees because the
number of children who have died last year common flu epidemic in USA were
from a combination of influenza infection and bacterial pneumonia – 64% of
these cases were due to the super bug methicillin-resistant Staphylococcus
aureus (MRSA). The increase is said to be five folds since 2004 (6).
We need to be very meticulous and observant before blaming or pointing our
fingers at cleaners for spreading infection knowing they are not trained
clinicians or nurses. We must watch what we do and not expect miracles cure
to end this war with bugs. I feel ethically uncomfortable when puncturing a skin
of a patient knowing this simple procedure could help entry of Antibiotic
resistant bacteria that could kill.
Reference:
1. http://www.telegraph.co.uk/health/3141079/Hospital-bacteria-such-as-MRSA-becoming-resistant-to-disinfectants.html
2. http://www.retrieverweekly.com/?module=displaystory&story_id=3960&format=html
3. http://www.medifix.org/safec/files/Canada%20Nurse%20Reduce_Vascular_Access_Complications.pdf
4. http://www.medifix.org/safec/files/reduceinf.pdf
5. http://www.slideshare.net/jben501/intravenous-therapy-1166327
6. http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0708flumrsa.html