Melanie Cole (Host): Two million people each year become ill as a result of hospital-acquired infections, and proper hand hygiene is critical to the prevention of these infections. My guest today is Dr. Joshua Cutler. He’s vice president of Quality and Safety at Maine Medical Center. Welcome to the show, Dr. Cutler. Tell us about infections, the spread of infections in the healthcare environment and how we can prevent them.
Dr. Joshua Cutler (Guest): There are certainly several factors, Melanie, that contribute to the spread of infection within hospitals. These days, I think that the issue is more important than ever because of the widespread use of antibiotics over the last several decades, which has been both huge advantage in terms of our ability to cure infections, but also has been a bit of a disadvantage because of the ability of bacteria to develop resistance to one or more or several antibiotics. We really have to be very vigilant about the potential of patients acquiring infections in the hospital that they didn’t have when they came. One of the major sources of infections in hospitals ironically enough are healthcare workers and providers ourselves. We can carry bacteria from one surface in a hospital room or one patient in a hospital to another part of the hospital and actually, in a way, a contaminator inoculate an uninfected person, especially a person who might be immunocompromised or more likely than most to get an infection with a simple inoculation with the bacteria we picked up someplace else. So most of that transmission occurs on the hands of healthcare workers, and that means that hand washing is the single most important way of preventing that transmission of bacteria and potentially bacterial infection.
Melanie: Dr. Cutler, tell us, as patients, to be our own best advocate, is it okay if when our healthcare worker comes into our room or into the room that we’re waiting to see someone, if we notice that they washed their hands or ask if they washed their hands? People feel very uncomfortable about that.
Dr. Cutler: It’s okay to ask that. It’s probably one of the single most important self-advocacy things that you can do or that a family member can do for you. That said, I know that’s not easy. Patients in hospitals are in an extremely vulnerable position and they perceive that and patients worry about alienating their nurse or their doctor by asking that and feeling that it’s not their place to ask, it’s an insult to ask or to be asked. But that said, I think all of us these days or at least the best majority of us really welcome that question. There are places where healthcare workers wear little buttons that say, “Ask me if I washed my hands.” But I think that in spite of the fact that it’s a difficult thing to ask, it really is a very legitimate thing to do if you, as a patient or family member, didn’t see the physician or nurse or other caregiver do that simple thing.
Melanie: Dr. Cutler, is it the same if we see them pump the hand sanitizer when they walk into the room and rub that all over their hands versus going to the sink and washing their hands?
Dr. Cutler: It is, and that’s a very good point. Hand sanitizers, which, for the most part, are alcohol-water combinations are very effective, at least equal, interestingly, to washing hands and take less time. We’ve tried, especially, some of the old areas of the hospital where there really aren’t well-placed sinks and soap dispensers all over the place, we’ve made sure that there are sanitizer dispensers easily available both outside and inside patients’ rooms and those things should be considered equal to hand washing.
Melanie: When, for the lay public, should we be washing our hands? We know, certainly, after going to the bathroom, but give the lay public a little kind of hand washing 101, when we should wash our hands and the right way and time length to do it. You’re a doctor, you’re the expert.
Dr. Cutler: I think that it may be legitimate to say that it’s more important in the hospital than anywhere, but I think that what our parents and teachers always told us is generally true outside the hospital, and that is, as you’ve said, you should wash your hands after going to the bathroom, and you should wash your hands before eating. You should wash your hands after handling money, and the reason to do that is because, not that that’s an inherently dirty thing to do, but money is one of those things that’s been handled by a lot of different people and it’s been in a lot of different places by the time it gets to you, and they do carry bacteria. Obviously, you should wash your hands when they’re dirty. You should wash your hands before taking care of your kids or handling food for other people, things like that. It is a lot of common sense, but I think that the transmission of bacteria by hands outside the hospital, probably important, but less important than inside.
Melanie: And as lessons go, you doctors, before surgery, before you come in to see us, you wash your hands for how long? And do you use antimicrobial soap or do you use a specific type of soap, or is just regular old Ivory just as good?
Dr. Cutler: The sort of soap that has an antimicrobial in it is what we use, and we use various kinds. We use hexachlorophene, we use chlorhexidine. Hexachlorophene, I think, is in some brands of soap; they’re available. Inside the hospital, for pre-surgical hand hygiene, for example, we use very powerful antimicrobials soaps and use them for very long period of time with instruments like brushes and so on, and those scrubs should go on for 6 to 10 minutes and they do. For routine hand hygiene before walking to a patient’s room, the general rule is to wash your hands with antimicrobial soap and water for a period of about 20 seconds, which is around how long it takes to sing “Happy Birthday” to anybody. That sounds silly, but it’s a good way of monitoring the necessary time without having to look at your watch.
Melanie: Dr. Cutler, in just the last minute or so that we have left, wrap it up for us, your best advice on hygiene and hand hygiene within the healthcare setting and why people should really feel confident at Maine Medical Center that this is being carried out.
Dr. Cutler: I think I have emphasized how important hand hygiene is. We, at Maine Medical Center, for years, have had major initiatives around making people, not only feel comfortable washing their hands more than they ever thought they might, but also feel the responsibility to do so. We measure it by means of observers who are kind of like secret shoppers on our patient care units who keep score on a periodic of how frequently—and hopefully it’s a 100% of the time—how frequently people wash before and after entering and leaving a patient’s room. The other thing we measure that’s important is we measure the transmission from patient to patient of certain types of bacteria, particularly dangerous ones that are resistant to multiple different kinds of antibiotics. These are things that people in the public are more or less aware of, like methicillin-resistant staph aureus or MRSA, or MERSA as it’s sometimes called, or “C diff” is another organism it’s sometimes called. We culture patients for the presence of these organisms when they are admitted to the hospital and during certain points in their stay. If a patient picks up one of these organisms in the hospital, we consider that a failure of our ability to contain the organisms and really a failure, among other things, of hand hygiene. I’m happy to say that we have a very low rate of transmission of those organisms from patient to patient within Maine Medical Center.
Melanie: Thank you so much, Dr. Joshua Cutler, vice president, Quality and Safety at Maine Medical Center. You’re listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcener.org, mmc.org. This is Melanie Cole. Thanks so much for listening.