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Wednesday, March 25, 2009

Post #16 Malpractice: Wash Your Hands or Risk a Lawsuit

I was cleaning out some of the interesting articles that I have collected over the past year and came across one of my favorites from the Wall Street Journal 2008. The essential premise of the article is that certain nosocomial (hospital-acquired) infections can be 100% averted if proper hygiene regimens are followed - beginning with, of course, hand washing.

Certain facts in the article jump out at me:

1. Nearly all hospital infections are avoidable when doctors and staff clean their hands and rigorously practice proper hygiene and other preventive measures.

2. Since October of 2008 (according to the article) Medicare no longer reimburses hospitals for nosocomial infections following orthopedic or heart surgeries.

3. Beth Israel Medical Center in New York City hasn't had a central line (a large IV placed in a major blood vessel) bloodstream infection in the cardiac intensive care unit in nearly 3 years!

4. If you don't wash your hands and you pass on a nosocomial infection, you risk being sued.

Bottom line: Infections can be avoided with good hygiene beginning with hand washing. This is important not just in the O.R. but in every aspect of healthcare.

A great additional read is an entire chapter dedicated to hand washing in Atul Gawande's book Better.

5 comments:

Catherine said...

yeah, hand washing is big at hopkins--the guy who started the whole use of checklists to prevent central-line related blood stream infections is here too

tiggertoy said...

Thanks for posting that. The only time I have been asking doctors and nurses regarding hand washing was when it came time to my child. 50% of the time I got belligerent responses from Nurses. I remember getting a really negative response from a Nurse that came in to give my 1 year old shots. She had long painted fingernails and no gloves and I never saw her wash her hands. I asked her if she could please wash her hands and she responded with a huff that she had been a nurse for 20 years and she washed them at the nurses station. When I talked to friends and family about this at the time (I was a new mother), I had friends that said, "What about the doorknob?" And families that said, "Well you obviously offended her."

I scratch my head, while I don't like to offend, my one year old could not speak for herself.

I need to start inviting those friends who mentioned the doorknob for thanksgiving. :)


Also, could you kindly blog about the Natasha Richardson's case? I understand some signs to watch for, but aren't there also regions of the head that are a lot more vulnerable to this type of injuries? I still could not understand how she could have hit her head so badly, low speed on powder?

I saw this just now:
http://www.cnn.com/2009/HEALTH/03/26/head.injury.emergency/index.html

Peter Jung said...

Tiggertoy,

It has now been reported that Natasha Richardson was disoriented after her fall. . .

The actress' vital signs were normal during the 4 p.m. ambulance ride on March 16, but she didn't know where she was, what day it was or what had happened to her, according to dispatch calls obtained by Toronto's The Globe and Mail.

This is key. Head injuries that result in loss of consciousness, seizure, or disorientation need to be evaluated a.s.a.p.

All other head injuries should be discussed with your doctor, but are not as precarious.

I think the initial reports scared a lot of people because it left out the important detail that she was disoriented.

I hope that helps!

Dr. Jung

Peter Jung said...

Tiggertoy,

One other note. In the past, I too (from time to time) washed my hands outside the room before I entered. A while back, a mom politely asked my nurse to request that I wash my hands in the room.

Afterall, how is the mom to know if I washed or not? Perhaps I should expect her to trust me, but the statistics and studies show that routinely doctors forget to wash their hands.

I have since made a noble attempt to always wash in the room upon entering so that the parent can feel assured that I have washed my hands. Even so, my guess is that I still forget every once in awhile.

There is a definite shift in the medical culture currently to make handwashing a top priority and also to make it acceptable for patients to remind a doctor to wash their hands. This can only make things better.

Dr. Jung

Carolina said...

Dear Mr. Peter Jung,
Thank you so much for posting this blog. I cannot believe how many lawsuits have been filed over patients contracting nosocomial (hospital-acquired) infections. This astonishes me, that surgeons and other healthcare providers don't take the time to fully prepare to see a patient. I am currently mentoring in a pediatric office and luckily all the doctors and nurses wash their hands before visiting a patient and also after. One of the nurse's also told me that in developing countries nosocomial infections are a major cause of preventable disease and death. I have also learned that the organisms causing most nosocomial infections usually come from within the patient’s own body, but they are not limited to contact with staff, contaminated instruments and needles,
and the environment. Another reason why MRSA is so common is because patients are constantly moving and hospital stays are becoming shorter and thus patients are often discharged before symptoms arise. I agree with insurance companies charging a lower premium to facilities who maintain a good posture on nosocomial infections, do you agree?
Thanks,
A future pediatrian