Wednesday, October 17, 2012

Is Your Hospital Making You Sick? Probably.

The Times of Israel reports about a recent Technion conference on hospital design which wondered how the design of the hospital affects patient health. The design matters a great deal in a way that many people fail to recognize: do health workers wash their hands? Shockingly, the answer turns out to be no.
The number, location, and position of hand-washing stations directly affects the health of patients, the study said. “Several studies of hand washing in high-acuity units with vulnerable patients have found that as few as one in seven staff members wash their hands between patients,” the study said. “Compliance rates in the range of 15 percent to 35% are typical; rates above 40% to 50% are the exception.” Studies show, however, that “installing alcohol-based hand-cleaner dispensers at bedsides usually improves adherence.”
What does this have to do with design? Health care workers, like everyone else, can be forgetful, lazy, inattentive, busy - you name it. And, if it's a pain to get to the hand-washing station and they've got a bunch of patients to attend to, they're not going to wash their hands. I originally wrote "forget to wash their hands", but if they're not washing their hands more than half the time, that's not forgetfulness; it's outright negligence.
(This also makes me wonder why someone whose relative died from a non-illness related infection in a hospital - and there are many thousands of them every year - hasn't sued the pants off the hospital for negligence. After all, we're talking about people washing their hands - or not washing their hands. One thing hospitals really understand very well is money. It's one thing if they're killing people. That's bad, and they try to do their best. But if it will seriously hurt their bottom line? You can bet they'll get on the hand-washing thing with a vengeance. Can you imagine a jury coming back with a not-guilty verdict after seeing pictures of some terrible infection and learning that it was because the nurse didn't wash her hands? I can't. Come on lawyers out there! I smell a class action lawsuit. Get on that!)

Truth be told, this is not shocking to me at all. As a rabbi, it became painfully obvious that a hospital is the absolute worst place to be sick, especially for senior citizens, who get admitted for one thing, and end of dying from another. If at all possible, insist on out-patient care. Have a visiting nurse. Get an IV brought to the house.
In fact, recent experience with very close family only reinforced this impression. Our grandmother entered the hospital following a fall (or a foot infection - I can't remember), and died several months later of a massive infection in the stomach, after enduring terrible trauma and suffering, spending the last months of her life in the hospital. Her husband, who was also terminally ill, entered hospice, and spent the last months of his life at home, with 24-hour care, in relative peace and comfort. (The NY hospice care was, I hear, amazing.) Which choice would any one of us opt for? We must begin to immediately take the long-term dangers of hospital admission into consideration when deciding whether hospitalization is really a good idea. (If you have seen it, Atul Guwande's New Yorker article on hospice is a must-read, especially for rabbis who give halachic advice about end-of-life issues.)

What if you are forced to spend time in the hospital? Can you protect yourself? Of course you can, by doing a very simple thing: Before anyone touches you (or your loved one, if the patient cannot advocate for him or herself), ask very forcefully: "I'm sorry I have to ask you this, but did you wash your hands?"
Be, for lack of a better term, meshugah about it. Ask every person, every single time, no matter how much you like your nurse or doctor. While you might feel uncomfortable about asking the same question every time, they're people too, and like us, they take shortcuts and make mistakes.
And what's a little emotional discomfort when your life may very well depend on your asking?