It is 3 in the morning. I am sitting in the darkened patient’s room here on the
10th floor in Mount Sinai Hospital, New York. The patient, who is now asleep
after a long day, is a local friend and I am here to accompany him in the
strange and intimidating world of big hospital medicine.
Meanwhile, I am
looking around and trying to absorb new ideas and lessons from this mecca of
medical care. My friend is asleep and I am jet-lagged, dozing in front of the
hospital computer screensaver that continuously displays, from left to right, a
red-on-blue message: “Hand Hygiene Saves Life.” This set me
We try to educate patients to have realistic expectations
when they seek healthcare, and to understand that medical interventions, however
helpful, come with risks. One of the more prominent and frightening risks is
Those contagions, also known as “nosocomial
infections” or “hospital-acquired infections,” are a global problem of epic
proportions. In the United States, the Centers for Disease Control and
Prevention estimate that roughly 1.7 million hospital-associated infections
cause or contribute to 99,000 deaths each year.
In Israel, there are
about 40,000 hospital-acquired infections (with positive cultures) each year,
and these are estimated to cause 4,000 to 5,000 deaths
Hospital-acquired infections occur because a hospital’s
environment is teeming with dozens of types of bacteria, many of which have
achieved strong levels of resistance to antibiotics. In addition, hospitals host
the perfect prey for these bacteria, patients with reduced resistance. However,
no small part of the blame rests on us, the physicians and nurses and other
staff members, since these hospital infections are transmitted significantly
more often when hospital personnel fail to regularly practice proper
Healthcare is an area where the public is led to believe that
the more costly and more advanced the technology, the better. Hand-washing is an
excellent example for shattering that myth. It is a simple, low-tech act which
is the single most important measure for reducing the risks of transmitting skin
microorganisms from one person to another and from one site to another on the
It has been proven in abundant studies that the risk of
infection is significantly reduced with strict enforcement of hygienic
There is absolutely no argument that washing hands between
patient contacts and after contact with bodily fluids is an important component
of infection control.
It is estimated that the spread of nosocomial
infections is connected with hand contamination of healthcare workers in almost
40 percent of cases.
The problem is a genuine challenge in most modern
hospitals in the Western world, and this is why the WHO launched the 2005 GLOBAL
Patient Safety Challenge that includes hand hygiene. We hospital administrators
are doing our utmost to make this change in behavior as easy as possible by
attaching the containers of antiseptic or alcohol-based gel in the most
convenient locations and even on each patient’s bed when possible.
harsh reality is that too many physicians and nurses in most hospitals, even in
advanced leading medical centers, don’t bother to carry out this very simple
practice. When we run inspections on staff adherence to hand-washing rules, we
find significant differences in behavior between open and concealed
The proportion of staff members complying with hand washing
rules sometimes drops by an astounding 50 percent or more when they believe they
are not being observed.
Hospital administrations are investing in rounds
of feverish meetings trying to figure out how to lower the rate of post-surgical
infections. To me, as a hospital director, this is a mind-blowing enigma: Why is
it so difficult to persuade physicians and nurses worldwide to take this simple
but critical step despite their knowing and genuinely understanding how
important it is to protect their patients from potentially lethal
Why is it that before they approach a patient’s
bed they ignore the container of cleansing gel and knowingly put their patients
at risk of contamination by resistant hospital-populated bacteria? Why are we
forced to seek technological methods to electronically monitor personnel
compliance, or weigh disciplinary enforcement of practices that are so obviously
Both the Mount Sinai and Sourasky Tel Aviv Medical Centers are large
tertiary hospitals serving diversified patient populations by using highly
advanced (and very expensive) treatment modalities and highly advanced (and
expensive) diagnostic technologies. Because of their reputations and
proven excellence, neither center has any problem in recruiting top-quality
nurses and physicians. Why is it then so difficult for us and many, many
hospitals all over the world to convince our excellent, intelligent and
otherwise highly motivated and accountable physicians and nurses not to behave
so irresponsibly by avoiding the simple life-saving act of washing their hands
before and after they have examined or treated their patients?
I have long been
seeking the key to this enigma, because with this key may come the solution.
What am I missing?
Meanwhile, I urge all patients in every hospital on the
planet: Do not be embarrassed. Always ask your physician, “Did you wash your
hands?” It may, at first, seem somewhat disrespectful, but what may appear to be
a little chutzpah may wind up saving your life.
Dr. Gabi Barbash is the
CEO of the Tel Aviv Sourasky Medical Center.