Monday, July 19, 2010


Medical Meanderings

Rub A Dub Dub (c)

In 1847, a young medical professor in Vienna, Austria, named Ignaz Semmelweis went to visit a sick friend. His friend, Jakob Kolletschka, was near death with a high fever, rapid pulse and sweats. Jakob had become sick soon after knicking one of his fingers while doing an autopsy and as Ignaz stood by his friend’s bed, watching him die decades before germ theory and antibiotics, Ignaz had a stunning insight: He had seen this disease before…in pregnant women.

Semmelweis had been troubled for years by the high death rate from “puerperal fever” in pregnant women in his hospital, where 13% of those admitted in labor died before hospital discharge. In a nearby obstetrical hospital run by midwives instead of physicians, the maternal death rate was only 2%. Now his friend Jakob had an illness very similar to puerperal fever from dissecting a dead body, and Semmelweis made a connection that would change medical practice forever.

Semmelweis had noticed that medical students would move from the autopsy room to the delivery room, wearing the same clothing and without washing their hands. On a hunch, he set up a policy: No one will be allowed to deliver a baby without first cleaning his hands in a chlorine solution. The death rate from puerperal fever on the labor and delivery ward dropped quickly to two percent.

Hand washing is the most basic weapon in the war against infectious disease. When done correctly, it can reduce the spread of many diseases. Unfortunately, it is rarely done correctly—in one study, 90% of hospital staff washed their hands for less than 10 seconds, instead of 15-30 seconds recommended by the Centers for Disease Control. Even in study situations, where people are being observed for compliance, only 40% of hospital staff washed their hands as they should have. Also, frequent hand washing is tough on the skin, causing changes in the types of germs present, and damaging the skin, possibly leading to a higher risk of transmitting infection.

Nowadays, alcohol hand rubs are becoming more widely accepted as the best way to clean hands. Alcohol hand rubs containing kill 90% or more of bacteria, viruses and fungi on the hands and reduce the risk of disease transmission from 92% with hand washing to 17%. Alcohol hand rubs work by breaking apart proteins in germs, and they work almost immediately. Also, they save time—whereas hand washing takes up to 30 seconds, the average alcohol hand rub is used in only 10 seconds. If you clean your hands five times a day, you will save 10 hours per year with a hand rub—that’s more than a full work day (or a good night’s sleep!).

Either way, by soap or by alcohol rub, in this season of colds, flu and strep, clean your hands early and often. Make Semmelweis proud. His insight, after all, eventually got him fired when the hospital administrator felt the policy change to be a criticism of his management. Science marches on, office politics doesn’t.

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