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Hand Washing Among Doctors

Discussion in 'Doctors Cafe' started by Dr. Emecheta C., Aug 15, 2019.

  1. Dr. Emecheta C.

    Dr. Emecheta C. Young Member

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    It is now generally accepted that hand washing is a very important practice not only for personal hygiene purposes, but for the good of others we come in contact with daily.

    This however, wasn't always the case. In 1846, Ignaz Semmelweis, a Hungarian doctor observed that the incidence of puerperal fever could be drastically reduced from about 10% - 1% simply by washing the hands with chlorinated lime water solution after performing autopsies.

    This led him to propose hygiene practices like frequent hand washing and sterilisation of instruments which led to a reduction in the spread of the infection.

    At this time, even though people knew to wash their hands before or after some activities like eating, using the bathroom, coming in contact with soil/dirt etc., there was no connection between poor hand washing and spread of disease.

    It was generally thought to be due to bad air, demons, or the like.

    You'd think Dr Ignaz would have been hailed and rewarded for this quite significant and historical discovery. He wasn't.

    He was instead shunned by his colleagues and cast into a mental asylum where he was beaten by guards and eventually died of septicaemia.

    It wasn't until years later that the Germ theory of disease was proposed by Louis Pasteur and accepted eventually.

    With this has come the advocacy for hand washing and other hand hygiene practices like the use of hand sanitisers in the absence of soap and water.

    The CDC as well as the NHS recommends hand hygiene as a simple, cost-effective strategy to prevent spread of infections, and the single most important strategy in the reduction and prevention of healthcare-associated infections.

    The 5 elements of Hand hygiene according to the WHO include:
    1. Before patient contact.
    2. Before a clean or aseptic procedure.
    3. After patient contact.
    4. After contact with the patient's environment.
    5. After contact with body fluids or spore-forming bacteria.

    Inspite of substantial and damning evidence in support of the importance of hand washing, compliance among doctors is still not as good as one would have expected.

    Several studies conducted to assess hand washing compliance among doctors and other health professionals have shown that a theory-practice gap still exists.

    A study conducted by 6 Canadian authors in 2016 and published in the journal of Hospital Medicine showed a significant disparity in hand washing compliance between covert observation and overt observation, which means that a good number of doctors would not bother to wash their hands so much if no one was checking.

    It was also observed that compliance was notably increased with concomitant motivation and encouragement from nursing staff and vice versa.

    Hospital-acquired infection is still a major cause of morbidity and mortality in hospitals.

    hand washing should begin to be regarded as a matter of morals and ethics amongst doctors.

    Continued education, awareness creation, and promotion of good hand hygiene practices remain key in the achievement of 100% compliance amongst doctors which is the ultimate aim.

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