Yahoo news story:

http://tinyurl.com/2rahza

“A British dentist was found guilty Thursday of urinating in his surgery sink and using dental tools meant for patients to clean his fingernails and ears.
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A medical tribunal said it was satisfied the evidence showed 51-year-old Alan Hutchinson, who “routinely” did not wear gloves or wash his hands, had risked the health of “himself, staff and patients” for more than 28 years.

A dental nurse who worked for Hutchinson for 16 years said she had caught him urinating in the sink more than once.

“He was tucking something into his trousers before zipping them up hastily. I walked over and I was behind him. He moved to the left and I could smell urine,” the nurse told the tribunal.

A later hearing will decide if the dentist’s unhygienic habits impaired his ability to treat patients, and if so, whether he should banned from practicing.”

I’m not going to panic and assume ALL dentists are doing this. But still…. how does this happen in a case like this? I’m sure his staff KNEW he wasn’t wearing gloves…. I guess if they reported him, he’d get shut down and they’d lose jobs??

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So if all of this discussion about hand washing is taking place, why the disconnect where we don’t have anything close to 100% compliance?

Sure it’s impossible to attribute a death to a single person not washing hands, but is that the point? Washing hands certainly can’t hurt, can it? Well if it does hurt the hand washer through dry chapped hands, the hospital should make good hand lotions available through wall dispensers (and many do).

I’ve seen studies that say over 60% of us carry MRSA around.

“No downside” to not washing…. other than knowing that you’re helping to spread germs around???

I agree that there seem to be many organizational cultural barriers that get in the way of good systems to ensure 100% hygiene.

We can’t just throw up our arms and say “oh well.” We have to try to do better.

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I’ve been in 30+ hospitals both in the UK and US.

In the UK signs, visual information are readily available on the impact of not washing, where one should and should not wash and the requirements to wash.

Information on washing compliance is discussed at every level from Trust Boards and Clinical Governance all the way down through Nursing and Management.

Audit results are well circulated from Board level down. Compliance levels are well known.

Root cause analysis is far trickier. It would be virtually impossible to attribute a HCAI death directly to an individual failing to wash their hands. Was it one of the 4 Consultants, 5 juniors, 20+ nurses, support staff, visitors, cleaners, physio’s, OT’s or someone else?

This would be even trickier to find out given that up to 30% of the population carry MRSA with no symptoms whatsoever.

One of the problems is there is no downside to a clinician not washing their hands. You can not discipline or otherwise castigate an individual that does not work for you. You can not prevent them from practicing medicine. If a nurse does it you could take them through a disciplinary on jeopardizing patient safety but for MD’s you cant.

Naming and shaming will not happen, not with front line staff who behave in a subjugated role to MD’s and Surgeons. They will not stick their head above the proverbial parapet to get it blown off.

Discipline systems work but when they are not applicable they are irrelevant and when dealing with Clinicians hospital disciplinary processes are irrelevant as most MD’s do not work for the hospital. (In the UK this is almost entirely the case)

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For clean manufacturing operations the introduction of coliforms into the process is like pouring a glass of sewage into a barrel of wine. It becomes a barrel of sewage.

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