Handwashing
January 2008

NEBRASKA: Hand gels alone may not curb infections
30.jan.08
N.Y. Times/AP
http://www.nytimes.com/aponline/us/AP-Hospital-Infections.html
Barfblog Post
OMAHA, Neb. -- Doctors and nurses on the go often skip soap and water in favor of an alcohol-based hand gel, thinking the quick-acting goo will kill bacteria on their hands and curb the spread of infection. It turns out that's not enough.
In a Nebraska hospital, medical workers, according to this story, nearly doubled their use of the alcohol-based gel, but their generally cleaner hands had no bearing on the rate of infections among patients.
The doctor who studied the problem pointed to many villains: Rings and fingernails that are too long and hard to clean, poor handling of catheters and treatment areas that aren't sanitized.
Dr. Mark Rupp, an infectious disease specialist at the University of Nebraska Medical Center, was quoted as saying, "Hand hygiene is still important, but it's not a panacea,"
The results of his study appear to contradict hospital guidelines from the Centers for Disease Control and Prevention that say better hand hygiene -- through frequent washing or use of hand gels -- has been shown to cut the spread of hospital infections.
Rupp, whose study appears in the January issue of Infection Control and Hospital Epidemiology, was further quoted as saying, "There are many factors that influence the development of hospital-acquired infections. It would be naive to think that a single, simple intervention would fix this problem."
The story notes that research has shown alcohol-based hand gels are more effective, faster and easier to use than soap and water. The findings of the new study were based on 300 hours of hand hygiene observations of nurses and doctors in two comparable intensive care units over a two-year period.
More gel dispensers were put in the units, and usage rose from 37 percent to 68 percent in one unit and from 38 percent to 69 percent in the other. Compliance for hand washing of any kind in most hospitals is estimated to be about 40 percent, according to experts, although some hospitals do better.
Every two months, bacteria samples were taken from health workers' hands, which were found to be cleaner when using the alcohol gel.
The infection rates in both ICUs were ''relatively low,'' the study said. And researchers found ''no significant relationship'' between rates of hand gel use and infections among patients. In fact, in one unit the infection rate rose when the hand gel was widely available and its use promoted.
Rupp said hospital-borne infections cannot be stopped by better hand hygiene alone because infections aren't limited to person-to-person contact.
He suggested hand gels be combined with other measures, such as better cleaning of hospital units, proper insertion and maintenance of catheters, and doctors prescribing antibiotics only when necessary so more drug-resistant bacteria don't pop up.
He also said hospital workers shouldn't wear rings and should trim their fingernails even more than the CDC recommendation of no longer than a quarter of an inch. Rupp said bacteria showed up when nails extended just beyond the fingertip.
On the Net:
University of Nebraska Medical Center: http://www.unmc.edu/
Centers for Disease Control and Prevention: http://www.cdc.gov/
Massachusetts General Hospital: http://www.massgeneral.org/

CANADA: 'No-brainer' hand-washing lesson costs taxpayer $16M
17.jan.08
Calgary Herald
Don Braid
http://www.canada.com/calgaryherald/columnists/story.html?id=9e9fad56-699d-4f0c-9da0-d051390a059a
Barfblog Post
According to columnist Braid, your mother always told you to wash your hands, but she never tried to charge you $16 million for the advice.
The province will spend that astonishing amount to promote "hand hygiene." Hand washing, to you.
Most amazing of all, the recipients of this advice will be the province's many thousands of health-care employees. Didn't they listen to their mothers?
Asked what all that money would buy, Health Minister Dave Hancock shrugged, sort of, and said, "sinks."
The story says that a report last summer showed that standards for infection control vary sharply among hospitals and regions, from good to bad.
Hancock is trying to create a central reporting and control system to make sure stringent, uniform standards are applied.
The goal is laudable, but for most Albertans, well or ill, it will seem patently absurd that a modern health system has to be taught about hand-washing.
Staff people are rushed and sometimes they forget, the minister says. Racing between patients or rooms without cleaning up can cause or aggravate illness.
With severe labour shortages, though, many nurses and doctors are lucky even to get to the next room, never mind staging a Hollywood scrub scene every time they move.
The story says that the initiative looks less absurd when we remember where it came from -- the richly funded East Central health region, in Premier Ed Stelmach's own riding.
A scandal last spring revealed a truly shocking picture; infection was spreading among patients because some staff people were not washing their hands.
Surgical instruments weren't being cleaned properly, either. Disgustingly, tissue from one patient was being planted in the next. Only through blind luck did the region avoid creating an epidemic.
All this had been known in the region, but wasn't reported to the government. That's what really enraged both Hancock and Stelmach.
Quintessential politician-bureaucrats, they launched a pair of studies, and Wednesday's announcement was the result.
There's more to it than handwashing: a new reporting structure, for one thing. But the results might be as much political as medical.
The province will have much more control over the system, and regional medical officers of health will become very powerful, indeed.

TEXAS: Train all food handlers
10.jan.08
San Antonio Express-News
Douglas Powell, Scientific director, International Food Safety Network at Kansas State University
http://www.mysanantonio.com/opinion/letters/stories/
MYSA011008.01O.letters0109.16a9f79.html
The regular publication of health department restaurant ratings addressed in the Tuesday editorial ( "Put eatery inspections scores on line quickly") underscores two broad conclusions that I have reached after watching the mish-mash of federal, state and local approaches to restaurant inspection in a number of western countries for the past decade.
All those who serve, prepare or handle food, in a restaurant, nursing home, day care center, supermarket or local market must require some basic food safety training
The results of restaurant and other food service inspections must be made public in all jurisdictions.
There should be mandatory food handler training, for say, three hours, that could happen in school, on the job, whatever. But training is only the beginning.
Just because you tell someone to wash their hands before they prepare salad for 100 people doesn't mean it is going to happen; weekly outbreaks of hepatitis A confirm this.
Next is to verify that training is being translated into safe food handling practices through inspection, and inspection results should be publicly available.
Such public displays of information help bolster overall awareness of food safety among staff and the public. People routinely talk about this stuff. The interested public can handle more, not less, information about food safety.

Live … From The SAFE FOOD CAFE -- Handwashing and hygiene in the produce industry
09.jan.08
International Food Safety Network (iFSN)
http://barfblog.foodsafety.ksu.edu/2008/01/articles/handwashing/safe
-food-cafe-handwashing-in-the-produce-industry/index.html
Subscribe at, http://www.youtube.com/SafeFoodCafe
This handwashing and good hygiene video is a few years old. It was produced by one time ifsn-ers Christian and Katija. It is intended for workers in the produce industry, but the handwashing techniques can be applied to anyone that handles food.