Health care should start with clean hands

Right after she entered the examination room, she washed her hands.

You got the sense right then that she would do everything in her power to ensure that she didn’t spread infection.

I thought of her the other day when a friend on dialysis in the Midwest told me what happened to him and his son.

What was supposed to be a life-saving transplant — the son donating a kidney to his dad — failed because of a hospital-acquired infection.

Now his son doesn’t have a kidney and my friend is weaker than before.

No one is sure now if the dirty hands of a health care worker spread the infection, but studies done by the Centers for Disease Control and Prevention show one of the key modes of close to 2 million hospital-acquired infections each year — there are 250 deaths from the infections each day — is via the hands of health care personnel.

Studies also show health care workers wash their hands less than half the time after direct contact with patients. The reasons local doctors and nurses gave me include skin irritation caused by hand hygiene, failure to remember or a preference for gloves.

Gloves, a recent study shows, are no guarantee of stopping infection, making workers less likely to clean their hands before and after treating patients. That’s a problem because germs can travel through latex gloves. Just taking off gloves causes a “back spray” effect, where fluids and germs are snapped back onto the wearer’s hands.

So doctors and nurses who don’t wash after using latex gloves spread infections through contaminated hands.

As hospitals try to find ways of forcing health care workers to wash their hands — some patient advocates favor public posting of hand washing rates and the firing of those who don’t comply — health officials tell patients to question their doctors and nurses about whether it’s being done. Of course, when you’re flat on your back and groggy in bed, that’s not easy to do.

It’s also not easy for many people to do in an office where they believe they’ve worked up a sense of trust with a physician. I find myself assuming — never a smart thing to do — that if I don’t see my doctor washing his hands, he must be doing it outside the exam room.

If there is a place in the United States right now where patients don’t find it difficult to ask about measures taken against infection, it may be in gastroenterologists’ offices in Las Vegas.

That’s the word from Dr. Frank Nemec and his team of physicians. Three or four times a week, he said, patients want to know whether his colonoscopies are carried out in the same way as those done at Dr. Dipak Desai’s clinics.

It was in February 2008 that officials began notifying 50,000 former patients of Desai’s clinics that they were at risk for hepatitis C and HIV because of unsafe injection practices — authorities said an outbreak was caused by reusing vials of the sedative propofol that were contaminated by syringes used on patients with hepatitis C.

Desai and two of his former nurse anesthetists face felony charges revolving around seven people who authorities say were infected with the hepatitis C virus.

As many as 250 former clinic patients now with hepatitis have filed lawsuits. Thousands more have sued over the stress of having to be tested.

Nemec said he doesn’t mind questions from patients — in fact, he’s contributed to the national “One & Only Campaign” that asks patients to question health care workers about whether they “use one needle, one syringe, one time.”

But he worries about those so fearful now of colonoscopies that they won’t get one. Colon cancer caught early by the test has a 90 percent survival rate, while patients whose cancer has spread have only a 12 percent chance of surviving five years.

According to the CDC, Nevada now has the fifth-worst colorectal screening rate in the nation, with only 56.8 percent of Nevadans older than 50 having had the proper screening.

“Before, there were years before inspections,” Nemec said. “Now they’re regular and unannounced. Las Vegas is now the safest place in the nation to get a colonoscopy. I’d hate to see people dying out of fear.”

Paul Harasim is the medical reporter for the Las Vegas Review-Journal. His column appears Mondays. Harasim can be reached at pharasim@reviewjournal.com or 702-387-2908.