Jane McCredie: Hands up for infection control

THE ability of unwashed medical hands and equipment to transmit disease from one patient to the next was a 19th century discovery.

So it is puzzling that, 150 years after Hungarian physician Ignaz Semmelweis discovered that the puerperal fever killing his obstetric patients was actually transmitted to them by their doctors, infection is still the number one complication of hospital admission in Australia.

Many, perhaps most, of the estimated 200 000 cases of hospital-acquired infection in this country each year would be preventable if basic control procedures were followed.

The fact that the federal government has seen the need to set up a National Hand Hygiene Initiative and that the World Health Organization has a similar global one makes it pretty clear that these procedures are lacking.

A study of US trauma patients now reveals something of the toll that hospital-acquired infections are taking in that country.

The mortality risk for trauma patients who developed sepsis was six times higher than for those who did not acquire an infection during their stay. For other hospital-acquired infections in this same patient group, the increase in mortality risk was between 50% and 100%.

There was a financial impact too: patients who acquired infections stayed about twice as long in hospital, incurring double the in-patient costs.

Infectious disease specialist Professor Frank Bowden knows only too well that trying to persuade clinicians to comply with hand hygiene rules can be about as successful as telling a teenager the internet is only for homework.

Professor Bowden, professor of medicine at the Australian National University, hopes data identifying the costs of poor infection control will help to change hospital practices that have become complacent about the issue.

Although hospitals have policies about hand hygiene, most have no mechanisms to ensure they are followed and no way of punishing non-compliance, he says. On top of that, power hierarchies within hospitals make it very hard for junior clinicians — let alone patients — to speak out for infection control.

“I am constantly amazed by the insouciance of my colleagues when it comes to infection control…,” Bowden writes in a forthcoming book. “Adoption of hand antisepsis is often thwarted by the intransigence of senior and influential clinicians.”

And what does he believe it will take to change things?

“Once it becomes clear to the patient population in general that there is a clear link between the behaviour of their medical attendants and the risk of them contracting an infection while in hospital, it is only going to take one high-profile case of a patient suing a hospital for the climate on hygiene to change.”

Let’s hope it doesn’t come to that.

Jane McCredie is a Sydney-based science and medicine writer, and a part-time publisher with NewSouth Books.

Disclosure: Frank Bowden’s book, Gone Viral, will be published in July by NewSouth Books where Jane McCredie is employed.

Posted 28 March 2011