Washing our hands of hygiene

It is not really possible to understand the Irish health service without some understanding of the attitudes and cultural backgrounds of the main participants.

Almost every single advance in the past has been due to a financial incentive – every time the government has wanted to improve services, they have always had to pay off some interest group. And because of that, and perhaps the avarice of some of those group’s representatives, it has become a truism that you can’t do anything, or change anything, without a pay-off to someone.

And because the health service is like a sponge that can never be saturated, money simply flows into services based on the perceived need at the time. There is little strategic thought put into an overall approach that would deliver a better overall service. ‘Fair’ in this context, means ‘fairer than before’, which by definition still means ‘unfair’.

It is bitterly ironic then that the media and public argue, in many cases, about the wrong things, and get upset about those things. If you asked the general public the reason why Savita Halapanavar died, many would say it was due to lack of abortion services in Ireland, lack of attention to her condition by her medical attendants, or poor supervision of her case. I think very few people would put the blame on a hospital infection  (septacaemia)- which was the real cause of her tragic death.

And though hospital infections have several causes – overcrowding and lack of proper facilities being just some of the potential causal factors – one of the major reasons for hospital infections is poor hand hygiene. Hand hygiene is relatively easy to operate and maintain. Very possibly, the average Irish sandwich has less germs than the average Irish patient.

But despite the huge importance of this issue, there is little urgency in dealing with the problem. All parties – the Department of Health, the HSE and HIQA have, like Pontius Pilate, washed their own hands of the hand-washing issue. What is the point, after all, of audits that find hand hygiene is at unacceptable levels in several Irish hospitals without doing something about it?

And since we know that money is a key driver of change in the health service, and extra money is patently not available, it seems obvious what must be done to improve standards, and therefore reduce infections and raise standards of patient care. And that is to make the connection between a poor HIQA report and money.

We see this happen in other areas of life and we are happy to punish offenders. If a restaurant or fast-food outlet is unhygienic, we close it down or we fine them. That is what forces the correction, not the wishful thinking that pervades the health service.

It  would be relatively simple and hugely transformative measure to cut budgets to hospitals and other institutions that received poor hygiene audits. And with a few other simple measures – such as the protection of whistleblowers within those institutions and the withholding of increments or bonuses while poor standards pertained – dramatic improvements would and could be made.

We have a system instead that is happy enough if the patients dies as long as there is regret and apologies that it happened, rather than putting in place a system that would cost no money, but would force (and it would seem force is needed) the application of ideas that have been around for a century and a half.

It is interesting to note that when the idea originated, the proponent, a Hungarian doctor named Semmelweiss was ostracised by the medical community at the time. Doctors then were insulted by the idea that they should wash their hands. Semmelweiss was an obstetrician and he noticed that the mortality rate in the doctors’ wards was three times the rate it was in the midwifes’ wards. He put this down to the cleanliness of the midwives and that they washed their hands.

The killer, at the time was a bacterial infection known as puerperal fever, which can develop into puerperal sepsis which is a serious form of septecaemia. It was common in the mid-nineteenth century and the mortality rate was anywhere between 10% and 35%.

Despite doing studies that showed that disinfecting the hands of doctors could reduce mortality to less than 1%, Semmelweiss’s theory was rejected by most of the medical community, and he died in a mental institution a few weeks after being committed  following a severe beating by his guards. It was only later when Louis Pasteur confirmed the germ theory of disease that his ideas began to gain widespread recognition and acceptance.

Except, of course, in Ireland in 2013.

There are many problems that beset the health service. And as I have said, the culture and attitudes of healthcare professionals play a big role in this. We may not be willing to insist on basic standards to the point of ultimately firing people who won’t adhere to them, but it is still possible to achieve these standards, without spending any money, if the will is there.

It is an insult to the very thing that should bind the medical community together – the application of science – that some individuals think of themselves not as doctors, nurses and scientists, but something weirdly different – priests or ministering angels who cure by their supreme intelligence and superiority, or their genuine and heartfelt compassion.

It is not a money issue, but we should use funding to change the status quo. We should cut back on funding to, and eventually eliminate institutions that can’t get their staff to wash their hands. Savita Halapanavar died of septacaemia, and many others may have perished because of the same problem. And that could have been caused by someone forgetting to wash their hands – something as banal and avoidable as that.

We can’t continue to just  wring our hands about it and claim nothing much can be done. We need to get everyone in the health service washing their hands as if their lives depended on it. Their patients’ lives certainly do.










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