Washing in Nursing and Medicine

¶ … Washing in Nursing and Medicine

The importance of antisepsis in medicine has been known for more than 150 years since physician Joseph Lister first suggested the germ theory of bacterial infection. Since then, antiseptic protocol has been a fundamental aspect of every facet of modern medical training. However, according to recent empirical evidence pertaining to the rate of hospital-acquired nosocomial infections among hospitalized patients, antiseptic protocol is being routinely ignored in many respects within the clinical environment.

Understanding the Problem

According to Oncology care setting design and planning Part II: Designing healthcare settings to prevent fungal infections and improve hand washing (Sheridan-Leos, 2008), hospital-acquired nosocomial infections affect approximately 1.7 million hospitalized patients in the U.S., resulting in almost 100,000 preventable deaths from complications unrelated to the original cause for hospitalization.

This problem accounts for a tremendous amount of unnecessary medical expenses, prompting the Centers for Medicare and Medicaid Services (CMS) to suspend further funding of various types of hospital-acquired infections (such as vascular catheter-associated infection and catheter-associated urinary tract infections), since October 1, 2008. That measure is intended specifically to motivate medical institutions to improve their antiseptic protocol compliance rates. In that regard, treating institutions are no longer eligible for federal subsidization for the treatment of such infections unless the patient presented with them initially. Furthermore, treating institutions may not bill patients for the additional cost of treating those types of infections either.

Identifying the Causes

According to the available research, infectious bacteria are typically found throughout hospitals, residing on medical equipment, food service carts, curtains, and virtually every conceivable fabric and hard surface. However, transmission to patients is rarely directly from these surfaces; rather, surface-residing bacteria are transmitted by hospital personnel from surfaces to patient as well as from patient to patient.

Moreover, the specific cause of transmission are the low compliance rates of hospital personnel with basic antiseptic protocols such as simple hand washing. Surprisingly, the worst offenders were those with the highest degree of formal training: namely physicians and registered nurses. In some studies, compliance rates among hospital personnel were only between fifteen and thirty percent. Finally, empirical studies have also concluded that compliance rates are lowest in high-volume institutions and among understaffed medical units.

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