Wednesday, January 30, 2008

No quick fixes in medicine - whoda thunk it?

To many non-medical people, it really appears they believe the "fixes" to medicine are simple, deterministic (i.e., computerization as a panacea), and that many of the problems are generally a result of bad behavior by clinicians. The significant brouhaha about handwashing is such an issue:

Cleaner but not safer hands?
A study found that even when use of a gel rose at a hospital, infection rates were unchanged.

By Timberly Ross , Associated Press, Wed, Jan. 30, 2008

OMAHA, Neb. - Doctors and nurses on the go often skip soap and water in favor of an alcohol-based hand gel, thinking the quick-acting goo will kill bacteria on their hands and curb the spread of infection. Turns out that's not enough.

Workers nearly doubled their use of the alcohol-based gel at a hospital here. Their hands were cleaner - but the rate of patient infections was virtually unchanged.

The doctor who studied the problem pointed to many villains: rings and fingernails too long and hard to clean, poor handling of catheters, unsanitized treatment areas.

"There are many factors that influence the development of hospital-acquired infections," said Mark Rupp, an infectious-disease specialist at the University of Nebraska Medical Center who led the study at the adjoining Nebraska Medical Center. "It would be naive to think that a single, simple intervention would fix this problem."

His research appears in the January issue of Infection Control and Hospital Epidemiology.

The spread of infection-causing germs in hospitals is a huge problem, accounting for an estimated 1.7 million infections and nearly 100,000 deaths each year, according to the Centers for Disease Control and Prevention. These include drug-resistant staph,urinary-tract infections, and ventilator-associated pneumonia.

Mike Bell, who deals with infection control at the U.S. Ceners for Disease Control and Prevention, said that while he did not agree that hand gels did little to reduce infection, Rupp was right to say they were just one part of the solution.

"If they don't do everything else right, having clean hands is not enough," he said.

Unfortunately, "doing everything else right" calls for keeping a hospital, medical equipment, etc. scrupulously clean. That requires significant resources - meaning, chemicals, people, and labor. The current precarious financial condition of many hospitals would seem to preclude that. The financial problems arise from a number of actors including mismanagement, too much management, and declining reimbursement from payors.

It would seem current leadership of healthcare organizations by cost-cutting, profit-motivated management, as well as the for-profit desires for payers, cannot compete with several billion years of microbial evolution.

-- SS


Roy M. Poses MD said...

See also this earlier post about in-store clinics:

The original proposals for MinuteClinics in Massachusetts did not include any plumbing in the clinics proper. Regulators later decided to require bathroom facilities nearby, and hand sanitizers in the clinics. Yet the research cited above suggests hand sanitizers do not work very well. This underlines the point I made in the original post that the business people who proposed such supposedly "disruptive innovations" do not understand the medical context, and their lack of understanding is likely to lead to badly designed health care systems, and ultimately bad patient care.

Anonymous said...

I read somewhere that its not so much the soap that does the trick as the water's washing away the critters.
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Anonymous said...

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Niagara Guide Guy said...

I work for a manufacturer that designs UV air sterilization units for hospitals. While I can fully understand Infection Control Professionals questioning the technology used in our devices, I cannot understand the mantra of many IC Professionals who appear to believe that all infection is contact in nature.
The aforementioned study demonstrates our position that there is no silver bullet strategy to reduce infections. We maintain that infections are environmental, and that any effort to reduce pathogens in critical care units is wise. While the role of airborne transmission in disease is not fully known, it should not be dismissed.
As the 'war' on HAIs builds, the legislators and lawyers will find that pinpointing the cause of an infection is a bit like catching smoke.
Joel A. Dombrowski
VIGILAIR Systems, Inc.
(editor: no need to include my company's name if you feel it is too promotional in nature.)

InformaticsMD said...

I cannot understand the mantra of many IC Professionals who appear to believe that all infection is contact in nature.

Joel, please read my caase study about Computers on ceilings of ICU's here.

It's what begain my interest in the social factors that create clinical IT mayhem.

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