Infection control across the pond

An upcoming issue of the Journal of Hospital Infection has a perspective written by Dr. Stephanie Dancer, the journal's editor. Entitled "Pants, policies, and paranoia...," her piece examines the push in the UK to reduce infections by focusing on the role of clothing and poor hand hygiene compliance in infection transmission. Her primary argument is that these issues are distractors from the real problems that are not being addressed by the National Health Service, namely suboptimal facilities that are suboptimally cleaned and understaffed.

She, like many others, argues that no studies have demonstrated that clothing transmits infections. You can read my counterargument here, but I'll simply state that no study has demonstrated that you need a parachute when you jump out of a plane either. Absence of evidence is not necessarily evidence of absence. But most disappointing is her fatalistic approach to hand hygiene: we can't improve it, so why bother? The reality is that with a lot of work, hand hygiene can be improved (see here and here), and I think this can have a major impact on the incidence of infections in hospitals.

I don't have any first hand knowledge about the state of hospitals in the UK, but I can tell you there are many beautiful, spacious, visibily clean hospitals in the US with terrible infection control problems. While it may be true that the NHS is using hand hygiene and bare below the elbows to divert the public's attention from infrastructure problems, I still think infection control is mostly about what happens at the bedside and how well healthcare workers observe good practices.


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