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17 Apr 2017

Simple act of hand washing the best first defence against infection

It’s the simplest method of infection control, it’s practically free and if it were always practised, it could save more than 1500 lives a year in this country –more than the road toll.

And yet it has proved difficult to get our healthcare workers – particularly doctors – to always wash their hands while treating patients.

This is not unique to Australia – indeed, while the latest audit by Hand Hygiene Australia found that doctors were only washing their hands around 80 per cent of the time before conducting a procedure, and even less often afterwards, ourrecord is actually better than that of the US or Britain. For decades, hospitals and health scientists have tested multiple ways to nudge health professionals to improve their hand washing rates. There would not be a sink at any hospital that didn’t have a sign above it prompting everyone to scrub up.

Indeed, in Australia the practice is overseen by its own organisation, the aforementioned Hand Hygiene Australia, which co-ordinates nationwide auditing of the practice.

Poor compliance rates feel even more worrying now that researchers are warning of a looming “post-antibiotic era” when superbugs become even more pervasive and deadly.

Monday’s edition of the Medical Journal of Australia featured a terrifying prediction from Professor Cheryl Jones, president of the Australasian Society for Infectious Diseases, about healthcare in a future where these antibiotic-resistant superbugs take root: “Simple childhood infections would once again be life-threatening events, major surgery would be associated with high mortality, chemotherapy for cancer and organ transplantation would no longer be possible.”

This is alarming but not necessarily alarmist – in February, the World Health Organisation released a list of 12 superbugs they warned posed enormous risks to human health, and urged hospitals to focus on infection control. In Australia, a nation with the highest per capita consumption of antibiotics in the world, the first defence against these threats is hand washing. It seems extraordinary to advocate for something this basic 170 years afterHungarian doctor Ignaz Semmelweis recommended the practice as a way of preventing women dying of puerperal fever in maternity wards. But while doctors are less likely to wash their hands than nurses and midwives (87 per cent compliance rate) or dentists and dental nurses (93 to 96 per cent), it would be wrong to infer that doctors care less than dentists aboutpatients’ wellbeing.

Indeed, one persistent finding from multiple hand-washing studies is that doctors are more likely to comply if the signs above the basins urged them to think about the impact on their patients’ health rather than their own.

Another campaign, and one The Age endorses, asks hospitals to encourage patients to check. The movement to empower patients has had encouraging results for healthcare around the world – even when it’s as simple, if awkward, as asking your doctors if they have washed their hands. But the latest Australian audit also points to a bigger, more complex problem.

The worst compliance rates are in our overwhelmed emergency departments. It’s understandable that the steady rituals of best practice are eroded when overworked staff are making life-and-death decisions. This workplace is a far cry from the orderly precision of the dentist’s suite.

Shocking stories emerged last week of staff at our emergency departments being assaulted, held hostage and even sprayed deliberately with blood by violent patients and addicts in the grip of ice psychosis.

Without sufficient security, special wards or beds, some of these violent patients have been put into comas for 24 hours to keep them from harming themselves or others. In scenes such as this, on the front lines of hospitals dealing with worst-case scenarios every day, it is little wonder that they sometimes forget to scrub up.

While behavioural nudges and campaigns and audits can go a long way towards improving our hand-washing rates, it turns out it isn’t that cheap a fix after all. To protect us all, we need to increase funding for hospitals to make our emergency wards a place of greater safety for everyone.

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