They’ve already invented such a device. Relevant [del]xkcd[/del] farside.
As a former CNA I apprecaited being allowed to use the sink in the patient room to wash my hands. I couldn’t always use the antibacterial soap because it made my hands crack and ble ed and I brought something from Bath and body works to use.
I will take a stab at this, although I’ve only worked as a unit clerk in the past and wasn’t in the patient’s rooms very much. Perhaps someone who has been in Housekeeping or in closer patient contact (or even someone who has worked on a unit more recently than I have) will come along with more info.
This is Housekeeping. When a patient leaves, Housekeeping is notified to come and make the bed (and all assorted furniture, phone, tv, etc) ready for the next patient. There is a protocol they follow, and it is different depending on the circumstances. I remember that if the patient had tested positive in the past for one of the resistant bacteria (MRSA, VRE, etc) then a Terminal Clean was requested when they left. They would then use different products that weren’t used all the time so as to prevent even more resistance (in the same way that you don’t get antibiotics from your doctor if you don’t need them) and extra tasks would be performed, e.g. the drapes around the bed would be replaced, etc.
Generally, though, the bed was removed and a new clean bed brought in for the sake of time. The beds themselves are cleaned thoroughly somewhere else in the hospital. The mattresses and pillows are actually covered in a plastic that is easier to clean than your soft ones at home.
All of the hard surfaces are wiped down with whatever product was appropriate and the fixtures (toilet, sink, etc.) thoroughly cleaned.
I don’t know about the alarm thing (I can see it being disconnected due to people complaining about it), but maybe something focusing on how it’s not just “doctors and nurses” who should wash… how clearly does the signage in your school point that EVERYBODY should wash when entering/leaving a sickroom?
I know my father’s BP shot every time he thought of the constant fight he kept with the cleaning staff re. “change the water and rinse/change mops/wiping papers for every single operating theater” - they saw absolutely no problem with using a single bucketful of water for all six. The part that made him angry is that many of the doctors didn’t either… he was the purchasing manager!
Heh, re-reading my post I did seem a little aggressive didn’t I? Truth is that I mulled it over for a while and typed it up over the course of a few hours as a homework distraction, and enjoyed the thought exercise. I always liked chemistry in theory…in practice it’s all pipettes and volumetric flasks and HPLCs and boring as hell.
I say it would be more efficient to use the unlimited resources to hire someone to follow nurses and doctors around and scream “DIRTY HANDS!!” whenever they fail to wash their hands.
I agree. There are already issues with noise in hospitals, one more alarm will just add to the ongoing din.
I think having a dispenser/door handle would be the thing. You can’t open the door without having the sanitizer dispensed.
StG
I’m sorry to be Devil’s advocate, but simply entering a room (assuming you don’t touch the door handle, the patient or their surroundings) doesn’t magically mean that your hands are contaminated if they were already clean.
Especially if you’re on rounds and have just sanitised your hands after leaving another patient’s area.
The WHO 5 moments of hand hygiene are:
Before touching a patient
Before clean/aseptic procedures
After body fluid exposure/risk
After touching a patient
After touching patient surroundings.
One doesn’t have to re-sanitise hands BEFORE touching a patient’s surroundings, if one hasn’t touched anything AFTER sanitising.
If one is merely going to stand in the room and talk to the patient (again, as commonly happens on rounds) without touching them or their surroundings there is no reason to sanitise if your hands are already clean.
One shouldn’t sanitise more than 6 times in a row- you need to use soap and water every so often. If your hands are visibly dirty soap and water is also the only way to clean them, sanitiser won’t cut it.
Also- in the case of an arrest -you’d probably not want that alarm sounding every time someone from the arrest team ran into the room, as usually they’ll have pulled on gloves en route, as they rather they didn’t waste 20 seconds with hand sanitiser if somebody needs resuscitating.
Me, when I worked in hospitals I eventually had a small bottle of occupational health sanctioned special sanitiser on my belt or in my pocket, because the hospital one has chlorhexidine, which made my skin peel, so you’d never see me using dispensers. I was also allowed by some sort of special dispensation to use iodine for surgical scrubs, which made me happy- I love the smell!
Now that I’m in general practice I can go a whole hour or more without touching a patient- lots of talking and very little examination in comparison to hospitals. I have a sink in my consulting room with my own choice of soap for handwashing- which is nicer than sanitiser or hospital soap, and the patients can watch me wash my hands, which is important.
I saw some time ago a docu about the problem of bacterial infection in the hospital, and how to adress poor hygiene (in relation to super-resistant bacteria; and also when a few scandals turned up that not all German hospitals are required to have a full-time paid hygiene expert).
They showed a procedure in one hospital where the hygiene expert would take a group (of nurses only, though), and have them do their routine procedure in a special teaching room. The surfaces were dabbed with harmless bacteria. Then a light was shined onto the hands of the people, and onto the surfaces in the room, to show how far bacteria had been spread.
I doubt that psychologically a technical solution will get high compliance from personnel who either dislike too-much handwashing because it damages the skin, or for other dumb reasons. A drastic show-and-tell example has a better chance of convincing people, and if a full-time hygienist regularly checks procedures with different methods, and different groups, then those who improve can be seperated from those who are obstinate (who should not keep working in that field).
That hygienist needs however a lot of power and clout to also adress the doctors and others.
Two thoughts:
First, pardon if anyone has already mentioned this but I didn’t see it on a fast read-through. Atul Gawande’s book *Better *has an essay on handwashing compliance. There’s versions of the essay available online, but those versions end before the part I think is most relevant here. Google Books should let you see it, though. Essay starts p. 13; part not usually online is pp. 19-27 with the best part starting p. 23. The key point is that handwashing compliance projects often don’t get much traction, but if you ask the people who need to wash their hands not "Why don’t you wash your hands?’ but “Why can’t you wash your hands?” – implying that people experience various obstacles to handwashing, which you are about to help them remove, not just that they’re lazy – and follow up on fixing what they talk about, compliance improves. Furthermore, it’s not the obstacle-fixing itself that is necessarily responsible for the improvement, but the engaging of people in coming up with their own solutions that does it.
The automated system would, in keeping with these ideas, work best if the staff come up with it themselves or at least choose it. If you impose it without their general endorsement, it’s likely the staff will find ways to circumvent it.
Second point: I think it’s much more likely to work with some kind of fine-tuning of the alarm function. As noted several times above, there’s a hell of a lot of random alarm noise in your average hospital room already, and anyone who works there has to have developed a tuning-out mechanism to survive.
A somewhat different view, but still not promising:
Damning with faint praise.
In short, they look like another scam, just like ‘antibacterial’ soaps.
I think you missed the point of that article, which (while it mentions problems with handwashing compliance in health-care settings) mostly says sanitizers don’t stop disease transmission in non health-care settings, such as homes and schools. Specifically, sanitizers don’t do much to stop flu, which is transmitted more by air than by hand.
I don’t have a cite handy, but it’s my understanding that in healthcare settings, sanitizers are equal to or better than soap-and-water as actually used, as opposed to as optimally used.
And that article says 60%+ alcohol sanitizers work great on not-visibly-dirty hands, while lower-strength ones don’t.
As the politician said, you go the hospital with the sanitizers you have, not the sanitizers you want. Maybe you’ll be the one to ensure all hospitals only use the correct sanitizers, and that all sanitizers are labeled to preserve health, as opposed to profit margins.
Well, in my experience, after the studies and that article came out (five years ago), it became tough to even find sanitizers with less than 60% alcohol. And I would be surprised indeed to find a hospital that thought its profit margin was better served by an increase in hospital acquired infections than by the difference between low-strength and normal-strength alcohol sanitizers. See WhyNot’s link in #7.
ETA: True, this all does assume that stuff labeled 60%+ really is 60%+ most of the time. Got me there.
I read Atul Gawande’s book, The Checklist Manifesto: How to Get Things Right.
IIRC, the worst problems were doctors, not nurses. The nurses were more likely to follow the procedures. I think one thing they did was to give out cash prizes to hospital staff that reported doctors not following the rules.
Here is another approach being tried at the University of Massachusetts Medical School.
http://www.telegram.com/article/20110122/NEWS/101220361/1116
I’ll add another vote as a nurse who doesn’t use the sanitizer every single time, and is still complying with the rules. If I wash my hands with soap and water at the sink inside the patient’s room according to CDC guidelines before leaving the room, and immediately proceed to leave the room, I am not required to use alcohol-based hand sanitizer at that time. Nor do I want to–I often feel more like I’m washing off all the gel and foam’s residue when I use water than I am ridding my skin of bacteria.
Someone else made another good point. If I am taking care of two patients, in rooms 1 and 2, it is not at all uncommon for me to perform care in room 1, disinfect on my way out, and take 3 or fewer steps to enter into room 2 without disinfecting at that time. In fact, by the time I enter room 2 I may still be rubbing the foam or gel into my skin. Another moment when I’m sure not about to push that dispenser again.
Noise level is a valid concern that has already been adequately addressed. I know that in the critical care unit in which I work, the noise level at night is the #1 complaint on our patient satisfaction surveys post-discharge. Adding another alarm (which yes, would be constant) would entirely fail to help.
I’m a little late getting back here, but I wanted to thank you for the reply. I knew nothing about this.