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    Physician, Heal With Thy Touch!

    May 30, 2017
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    Hygiene is crucial to the healing touch of the physician's hands. Education and proper protocols can ensure hand hygiene for patient-safety. Physician, heal thyself!


    Hygiene is crucial to the healing touch of the physician's hands. Education and proper protocols can ensure hand hygiene for patient-safety. Physician, heal thyself!


    Hygiene is crucial to the healing touch of the physician's hands. Education and proper protocols can ensure hand hygiene for patient-safety. Physician, heal thyself!



      Hand hygiene is a universal need in a world teeming with microbes and pathogens waiting to catch a break to attack! It is not culture specific. Its practice also transcends geography and time.

      Consider Exodus 30:18-21 of The Bible: 'So they shall wash their hands and feet, so they die not.'

      Or, the Qur'an: 'For Allah loves those who turn to him constantly, and He loves those who keep themselves pure and clean'; even to the extent that 'cleanliness is half the faith.'

      The Vishnu Purana, the ancient Hindu text, advocates a detailed procedure to maintain hygiene which includes, among numerous other detailed instructions in those ancient times of its authorship, a fistful of earth to be used to scrub hands before using water.

      However, hand hygiene as a scientific prerequisite to control the spread of infections can be traced as far back as the 180-year publications by Dr. Ignaz Semmelweis in prominent British and Austrian medical journals.

      The importance of ‘clean hands’ is, thus, not uncharted territory.

      Physician: Heal thyself!

      Who do the sick turn to first for medical attention? The Physician.

      The first step in the healthcare sector’s march towards acceptable standards of hand hygiene as a means of controlling and avoiding the spread of pathogens should address physicians first and foremost.

      This is easier said than done: hand hygiene may seem a simple procedure but takes on complex proportions when the hands in consideration belong to a physician.

      A 2014 study observes that the two prerequisites for driving widespread hand hygiene practices in physicians are

      • Knowledge: Hand hygiene awareness and importance to daily patient care should be built into the education and training systems for physicians. The dissemination of scientific information about the link between hand hygiene and the transmission of pathogens supported by studies, facts and figures, should be a priority if there is to be any seriousness about hygienic practices amongst physicians and health care workers.
      • Skills: techniques of maintaining hand hygiene must include the procedures for washing, the efficacy of different kinds of soaps and sanitizers as well as skincare and protection.

      Any drive to implement hand hygiene practices will have to address these two considerations of education and training.

      Driving hand hygiene in the community of Physicians envisages pro-active measures all the more because many do not consider hand hygiene to be the standard operational procedure (SOP) when providing patient care.

      Why the reluctance?

      A study of SOPs in health care establishments throws some light on why many hands do not make hand hygiene work:

      • Low prioritisation: this can be for many reasons ranging from awareness to the pressure of work.
      • Insufficient time: the press of patients, especially where the physician: patient ratio is low. High workloads and understaffing do not leave much time for hand hygiene.
      • System constraints: access to or inconvenience of hand sanitizing equipment placement or the lack of sinks. This may be a factor in larger establishments where housekeeping is separated from medical work, but not a viable reason in smaller or single-physician driven practices. Large healthcare facilities might see hindrances like empty sanitizing dispensers and difficulty in locating products.
      • Allergy and intolerance to antiseptics and sanitizers. Alcohol-based sanitizers with either isopropanol, ethanol, or n-propanol seem to be kinder on skin. Alcohol-based emollients also make sanitizers more tolerable.
      • Forgetfulness, especially under pressure of work
      • Lack of leadership in driving a sustained and sustainable hand hygiene programme.

      Will should find a way

      A 2013 paper argues that there is a gap between theory, practice and ethics as far as physicians’ compliance to hand hygiene protocols is concerned.

      • Recommendations based on scientific evidence may not be sufficient to get physicians to adopt a devoted regimen for clean hands.
      • Physicians should be reminded about their moral and ethical obligations.
      • Hand hygiene should be made a contractual obligation at the very commencement of medical practice or employment.

      Healthcare Organisations(HCOs) must also put mechanisms in place to monitor such compliance:

      • Constant reminders will encourage compliance
      • Appropriate rewarding will ensure adherence
      • HCOs must also provide feedback to physicians and all other healthcare workers

      In short, a conscious decision followed by a hand hygiene protocol with a system of constant reminders and reviews is the need of the hour.

      Leaders of the pack

      Physicians, belonging as they do to the class of influential professionals, can encourage effective hand hygiene practices among other sections of healthcare workers like nurses and attendants.

      Residents and medical students also copy the behaviour of their superiors. Physicians, setting a good example with their self-adherence to hand hygiene protocols, serve as good role models to further the cause of health, patient-safety, and self-protection.

      Health is indeed wealth. Physicians can help spread this largesse with their efforts to maintain and spread the message of hand hygiene as a simple but effective tool to halt the spread of harmful microbes.

      Author: Dr. Sankar Sengupta, MBBS, MD(Micro), Dip-Diabetology, PGDHHM(Symbiosis)

      Medical Superintendent, B.M.Birla Heart Research Centre, Head Quality – C.K.BIRLA GROUP OF HOSPITALS, Kolkata, Honorary Professor & HOD(Microbiology) Institute of Child Health, Kolkata

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