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Friday, March 12, 2010

Health Care Reform: "Did You Wash Your Hands?"

A Friday gift for my conservative readers: I'll advocate health care reform that has nothing to do with big government and everything to do with personal responsibility. If you want to drive down health care costs and reduce hospital infections and deaths, do one simple thing: be annoying. When you go to the hospital, ask any doctor, nurse, or anyone else who tries to touch you, "Did you wash your hands?"

Asking a simple question like that challenges the standard hierarchy of of medical decision-making where the doctor knows best. As Dr. Peter J. Provonost of Johns Hopkins Hospital tells the New York Times, challenging that hierarchy is one of the reforms health care needs. He tells Claudia Dreifus about his efforts to get doctors to follow simple checklists to reduce medical errors:

As at many hospitals, we had dysfunctional teamwork because of an exceedingly hierarchal culture. When confrontations occurred, the problem was rarely framed in terms of what was best for the patient. It was: “I’m right. I’m more senior than you. Don’t tell me what to do.” With... infection after a catheter insertion, our rates were sky high: about 11 per 1,000, which, at the time, put us in the worst 10 percent in the country.

Catheters are inserted into the veins near the heart before major surgery, in the I.C.U., for chemotherapy and for dialysis. The C.D.C. estimates that 31,000 people a year die from bloodstream infections contracted at hospitals this way. So I thought, “This can be stopped. Hospital infections aren’t like a disease there’s no cure for.” I thought, “Let’s try a checklist that standardizes what clinicians do before catheterization.” It seemed to me that if you looked for the most important safety measures and found some way to make them routine, it could change the picture.The checklist we developed was simple: wash your hands, clean your skin with chlorhexidine, try to avoid placing catheters in the groin, if you can, cover the patient and yourself while inserting the catheter, keep a sterile field, and ask yourself every day if the benefits of catheterization exceed the risks.

Q. Wash your hands? Don't doctors automatically do that?

A. National estimates are that we wash our hands 30 to 40 percent of the time. Hospitals working on improving their safety records are up to 70 percent. Still, that means that 30 percent of the time, people are not doing it [Dr. Peter J. Provonost, interview with Claudia Dreifus, "Doctor Leads Quest for Safer Ways to Care for Patients," New York Times, 2010.03.08].

A single-payer system will also save money and save lives. But while we wait for Stephanie Herseth Sandlin to develop a case of Kucinich courage, we can do some small do-it-ourselves reforms which challenge the prevailing hierarchical hospital culture and prevent unnecessary expense, sickness, and death.

Bonus reading: You might also want to ask your doctor if you really, really need that colonoscopy. (Now he tells me, says Mr. Epp.)


  1. I think I may be going off topic here so let me know if you disapprove.

    Where are the gloves in all this?
    I'm in the food industry and we have to wear gloves to protect the people. I can't stand this but do it anyway because it is SD law. I use the medical industry as an example. Doctors and Dentists use gloves to protect themselves and that prevents patient to patient contact because the gloves are removed from room to room or patient to patient.

    The article said nothing about gloves. I am certain that gloves are being worn while inserting the cath, And infections still come about?

    So are they donning gloves and then picking up the clipboard or file? Touching the countertop? Adjusting the exam table? Touching the patients clothing? Just because gloves are being worn doesn't mean its an automatic sterile environment on the hands. What ever is transmitted from object to hands still happens. Now it is just on top of the glove while the glove wearers hand is protected.

    Also for anyone who has to wear gloves, the hands still have to be washed. Because you touch the outside of the glove as you are grabbing them out of the box and putting them on. Gloves do not replace handwashing.

    Was there any reference to gloves elsewhere in the article?

    April Schave

  2. Gloves—not with respect to hygiene, but Dr. P. does tell a riveting story of seeing a patient going into severe allergic reaction to latex gloves and the surgeon refusing to listen to warnings.

  3. The whole concept of hand washing and its importance in cost reduction within the health care sector is quite apparent when technology is being developed, has a market and is being introduced to enforce hand washing by medical staff. That this sort compliance control can be automated and save money indicates how much of a problem hand washing really is.

  4. Well, thats scary. I thought the patients were supposed to ignore symptoms, because health insurance sucks.

  5. Checklists make sense for all kinds of hospital procedures. Cost is next to nothing compared to benefits.
    Scandinavian protocols for handwashing,etc cut hospital infection rate to near zero. The Veterans administration medical records system is available free.

    It is hard for me to comprehend why the health industry continues to needlessly kill patients and waste money like it is dirty water when low or zero cost options are available. The number of people who die each year because of hospital borne infections and errors avoidable by checklist use is appallingly large.


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