Page 6 - IQ February 2018

consPicuous sHoPPer
Ramzy Nasrallah CEO | AVA AVA & the AVA AVA Founda on on Emily Levy is a a a a professional pa ent who lives with a a a a a a PICC so she knows what comprises proper asep c c c c c technique and and best prac ce ce for catheter care and and safety A recent visit to to the the clinic reminded her not to to take that for granted:
Spent the day day at [a hospital in New York] for a a a a a a a a full day day of tes tes ng ng Not once once once once did an alcohol wipe come out to be used on on on my PICC or tes tes ng ng devices unless I repeatedly asked What’s a a a a a a a good way to educate these medical professionals who you you desperately need their help but you you don’t want to insult them?!
Emily posed an an an an an important ques on and and problem that that that AVA is is trying to to answer and and solve To do that that that properly let’s rst look at at at at at the history of failure that that that dominates healthcare delivery’s infec on on preven on on story story And while that story story includes catheter care care it it it begins with hand hygiene - and and the the culprit has never changed Nobody inched back in in in 2016 when the CDC introduced its Clean Hands Count campaign to to to urge clinicians to to to to to comply with handwashing protocol Nobody said hooooold on we need to to to to to remind doctors and and nurses to to to wash their hands? In 2016? Doesn’t the the Hippocra c c Oath begin with “First Do Do No Harm?” Isn’t that oath several thousand years old? And doesn’t doing no harm begin with handwashing?
Nobody said any of that because we live in in a a a a a a a a a post- handwashing compliance world where a a a a a a a a a a a en on to process is overlooked much in in the same way Emily’s PICC was The rates by which doctors nurses - - and and anybody really - - prac ce ce e e e e e e e e e e e e e e e e e e ec ve ve hand hand hygiene hygiene have been dismal quite literally since hand hand hygiene hygiene was rst conceived We bemoan them them we we we campaign to to make them them be be er
we we we succeed brie y and then we we we regress to to the the mean Germ Theory was rst proposed almost half a a a a a a a a millennium ago by Girolamo Fracastoro who suggested diseases were being spread everywhere by ny organisms we we couldn’t see (as opposed to to evil spirits) but that that didn’t p p p p p p us o o o o o o o o o to to the value of hand hygiene in in in hampering that that process That clue appeared in in in in in 1847 when Jakob Kolletschka was inves ga ng why pa ents in in in in the the doctors’ wards at the the Vienna General Hospital obstetrical clinic were contrac ng ng and dying from postpartum infec ons three mes more o o o o o o en en than pa pa ents in in in the midwives’ wards Kolletschka never nished his inves ga on because he he he died as a a a a a a a a a a a result of it it when a a a a a a a a a a a medical student accidentally cut him with a a a a a a a a a a a a a scalpel while performing a a a a a a a a a a a postmortem examina on on on on on on a a a a a a a a a a a deceased mother from a a a a a a a a doctor’s ward The resul ng infec on on on killed him him Evil spirits were not immediately ruled out He himself became the clue when his friend Dr Ignaz Semmelweis no ced he he he he he presented with a a a a a a a a similar pathology to to to the the the cadavers from the the the doctors’ wards He proposed the the the connec on on had to to to be physician hands Doctors at Vienna General were conduc ng ng autopsies and and then heading directly into labor and and delivery without washing up Midwives were not conduc ng ng autopsies hence the the disparity in in in in infec on on rates and and and why the the outcomes were superior in in in in that ward Perhaps washing hands between corpses and and and mothers would help reduce the the frequency of those infec ons!
Semmelweis implemented a a a calcium hypochlorite solu on for scrubbing hands between procedures He did not test its e e e e e e e e e e e e e e cacy he he simply guessed it it it might work work because it it it was good at making the funky smell from working on cadavers go go away when he he he applied it it to to his own hands He gured it it might just work to to reduce infec ons as well His interven on on on - - hand hygiene - - prac cally eliminated mortality in in in the the unit Upon implementa on on on the the 6 | | IQ | | Intravascular Quarterly neWsletter | |