Clean Hands Save Lives - and now there's a book to prove it!

As most of you know, 5 May is the WHO World Hand Hygiene Day. This year's campaign is called "SAVE LIVES: Clean Your Hands campaign - ’No action today; no cure tomorrow – make the WHO 5 Moments for Hand Hygiene part of protecting your patients from resistant germs."

In honor of 5th of May and to further promote hand hygiene and the concept "Economy of Peace," French author Thierry Crouzet has authored a book describing the journey of Didier Pittet and WHO in promoting hand hygiene internationally. The book is available for purchase in print or epub and also for free in 6 languages (no Croatian?!). In addition, this group has created a new website/organization called CleanHandsSaveLives.org.

For hand hygiene fans, after you read the late Sherwin Nuland's story of Ignac Semmelweis, this could be next on your list.

Prevention, anyone?

Thanks to Eli’s recommendation, I watched the Frontline documentary on antimicrobial resistance last night. The culprits (MRSA, pan-resistant Stenotrophomonas, NDM- and KPC-producers) are fearsome, and the stories are riveting. The most haunting line is exactly ten minutes in, when Will Lyman (the somber voice of Frontline) intones that “Addy and her mother had entered the post-antibiotic era”. The statement is both shocking and true, and one we’ve covered before. Overall, this is perhaps the best lay media treatment of this issue that I’ve seen, and features many of our eloquent friends and colleagues. In particular, pay attention to Dr. John Quinn, an expert in gram negative resistance who died earlier this month after a battle with cancer. He will be sorely missed. You can watch the documentary in full here. 

One minor criticism: too much emphasis on drug development and new technology (e.g. whole genome sequencing, “robot” cleaning), not enough discussion of the hard work of basic infection prevention (hand hygiene, contact precautions, environmental cleaning). I know from discussion with those involved that these topics were discussed during interviews, but probably not deemed compelling enough to survive the editing process. New drugs buy some time and can be life-saving, but only until bacteria catch up…..and genome sequencing didn’t halt the NIH outbreak, strict enforcement of basic prevention measures did. I hear a lot of general nihilism about hand hygiene (adherence rates will never exceed 60%, high rates can never be sustained, etc., etc.). The truth is that we have much more work to do to better understand and solve the hand hygiene problem. 

Frontline plans a second show in the spring of 2014 that covers the role of antimicrobial use in driving resistance, which I look forward to seeing. Might I suggest they begin planning a third installment, dedicated exclusively to the problem of hand hygiene in healthcare settings?

Photo of Ignaz Semmelweis from Wikipedia Commons

Semmelweis was right!

We do a lot of blogging about hand hygiene, and Eli frequently points out the dearth of well-designed studies examining improvement approaches and/or the relationship between HH improvement and reduced infection rates.

In that context, I’d like to recommend this quasi-experimental study from Kathy Kirkland and her colleagues at Dartmouth, published last month in the BMJ Quality & Safety journal. Eli can inform us as to whether it would have “made the cut” for the 2011 Cochrane Review, but I really like this report. The interventions and setting are clearly described, more than one measure of HH is used (direct observation + product use), infection rates are reported over the entire time period, and the discussion section is thoughtful.

There are limitations to the work, but I encourage those who haven’t yet seen it to read it. Mike can add his experience here, as I think his group does more monthly observations, and has had a similar HH journey. I’ve also long been skeptical that rates of 90% can be achieved or sustained in settings where observations are truly clandestine (as I think in most hospitals the HH observers quickly become quite familiar to unit personnel). I’d love to be disabused of this skepticism, if it is indeed misplaced.


Figure from Kirkland KB, et al. BMJ Qual Saf 2012;21:1019-26.

What is your name sir?...Ignaz

Loreen Herwaldt (and thanks to John Boyce) just forwarded along this cinematic depiction of Ignaz Semmelweis and his early investigations into the benefits of hand hygiene. The piece was written/directed by Jim Berry at NYU back in 2001 and funded by a Sloan Foundation grant for scripts featuring positive depictions of scientists. The film is a bit graphic/realistic. 

My favorite quote is from the mother pictured above: "You have a gentle touch sir, I want you to be my baby's namesake. What is your name, sir?"  A: "Ignaz"

Another moving section:  Semmelweis: "I believe that this practice will save lives."  Senior physician: "but this is not our way, at this hospital, doctor, we must be unbending in our practice."

The film is available for viewing on the Sloan Science and Film website (here)

Happy Weekend: Didier Pittet on Yesterday and Tomorrow's Heroes

Do you have any time left?  Yesterday I posted Günter Kampf's talk on hand hygiene from Medline's third annual conference called Prevention Above All.  Today we have Didier Pittet speaking on Preventing Healthcare-Associated Infections: Pioneers of Yesterday - Heroes of Tomorrow.  Lot's of history: Florence Nightingale and Ignaz Semmelweis. Enjoy