www.agonist.org/20070326/on_washing_hands -
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Published on: 3/27/2007
Last Visited: 3/27/2007
Agonist Reviews - One ordinary December day, I took a tour of my hospital with Deborah Yokoe, an infectious disease specialist, and Susan Marino, a microbiologist.
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Yokoe is forty-five years old, gentle voiced, and dimpled.She wears sneakers at work.
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Yokoe and Marino have seen measles, the plague, and rabbit fever (which is caused by a bacterium that is extraordinarily contagious in hospital laboratories and feared as a bioterrorist weapon).
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The hardest part of the infection-control team's job, Yokoe says, is not coping with the variety of contagions they encounter or the panic that sometimes occurs among patients and staff.Instead, their greatest difficulty is getting clinicians like me to do the one thing that consistently halts the spread of infections: wash our hands.
There isn't much they haven't tried.Walking about the surgical floors where I admit my patients, Yokoe and Marino showed me the admonishing signs they have posted, the sinks they have repositioned, the new ones they have installed.
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Still, it took Yokoe over a year to get our staff to accept the 60 percent alcohol gel we have recently adopted.
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Yokoe receives the daily tabulations.I checked with her one day not long ago, and sixty-three of our seven hundred hospital patients were colonized or infected with MRSA (the shorthand for methicillin-resistant Staphylococcus aureus) and another twenty-two had acquired VRE (vancomycin-resistant Enterococcus) -- unfortunately, typical rates of infection for American hospitals.
Rising infection rates from superresistant bacteria have become the norm around the world.The first outbreak of VRE did not occur until 1988, when a renal dialysis unit in England became infested.By 1990, the bacteria had been carried abroad, and four in one thousand American ICU patients had become infected.By 1997, a stunning 23 percent of ICU patients were infected.When the virus for SARS -- severe acute respiratory syndrome -- appeared in China in 2003 and spread within weeks to almost ten thousand people in two dozen countries across the world (10 percent of whom were killed), the primary vector for transmission was the hands of health care workers.What will happen if (or rather, when) an even more dangerous organism appears -- avian flu, say, or a new, more virulent bacteria?"It will be a disaster," Yokoe says.