“It’s like going to war every day,” said Winnipeg Regional Health Authority CEO Arlene Wilgosh to a packed audience last month at the 18th annual Bug Day held at the Health Sciences Center. Arlene Wilgosh is referring to our battle against hospital bugs, those invisible creatures that kill more than 8,000 Canadians a year – every year – making Hospital-Acquired Infections Canada’s fourth leading cause of death. (Why not Hospital-Caused Infections?)
The good news is we know what to do about it: “Wash your damn hands,” says Wilgosh, since 80% of these infections are spread by healthcare workers, or patients and their visitors. The bad news, she says, is that we just aren’t doing it. Only 70% of nurses comply and an embarrassingly low 38% of doctors – if that. It’s been suggested that even these numbers are inflated because staff know when the hand washing police are watching and will thus “buckle up.”
Since healthcare worker noncompliance with hand hygiene rules is epidemic, a U.S. healthcare company has come out with a smart watch that shows whether nurses and doctors have washed their hands before they walk into patient rooms. The company describes how it works: “The watch detects motion and it knows when a wearer goes from room to room. As soon as I leave a room, I need to be aware that I should be washing my hands. So the watch has a color-based alarm that goes off as I change rooms. Now the watch instead of being green is red, and based on a period of time, we also change that to yellow to give clinicians the indication that they should be washing their hands for sepsis control.”
While the company claims to have “tracked a reduction in infection,” an insightful reader – a microbiologist – wonders if the technology might have the opposite effect: “You know what I never see is a comment about the watch itself (any watch). You can’t sterilize a watch, you can’t even clean most very well. You could clean and sterilize the watch band, if you want to take the time to remove the watch from it. That watch sees many patients a month. That watch can catch all types of particles [germs] …”
Britain’s National Health Service agrees. On the basis that bugs attach themselves to what healthcare workers wear, 8 years ago they enacted a “bare below the elbow” dress-code. Every doctor, nurse and therapist is banned from wearing watches, jewelry – such as rings and bracelets, and neckties. They also banned the traditional white lab coat and replaced it with a short-sleeved blue tunic with pockets made of a quick-drying antimicrobial fabric, which actively repels bacteria. Since the policy was instituted, instances of MRSA cited on death certificates has fallen by 77 per cent.
U.S. support for the idea that bugs hitch rides on what we wear comes from research published this year in the Mayo Clinic Proceedings. It tells us that stethoscopes carry more MRSA and other bacteria after a physical exam than all other areas of the physician’s hand except the fingertips.
If Arlene Wilgosh is right to use a war metaphor to deal with infection, then we need to think about being smart soldiers. The Greeks tricked the Trojans – infiltrated their ranks – with a daring, ingenious plot using the best technology of the day, a wooden horse big enough to hide its soldiers. So we forgive the Trojans for being duped, even sympathize with their misfortune. But what would we think of them if we discovered, instead, that they were the ones who built the Horse?