Wednesday, April 9, 2014

Hand Hygiene

Children with cancer in developed countries have a 1-3% chance of dying of infection.  Children in developing countries have at least 25% chance of dying with they contract infection.  This is due to delay in treatment of infection in the developing world.  In Canada, parents of children with cancer are told to bring their child to the hospital immediately if the child develops a fever; however, in Bangladesh, parents often wait and observe their child at home for a day or two before bringing them to the hospital.  This delay means that the child is much sicker by the time they arrive at the hospital and the infection may be so advanced that it is not possible to cure the infection, even with strong antibiotics.

In Bangladesh, the most common cause of death in children with cancer is severe overwhelming infection (this is often called sepsis).  Many of these infections are acquired in the hospital due to poor infection control practices.  I think that this recently published article illustrates the scope of the problem in Bangladesh (not that developed countries are perfect, typically hand hygiene rates are 20-30%),

There were 32 episodes of hand washing when there should have been 3373!!!  The ward where I am working has one sink with soap as well as 10 hand sanitizer dispensers, but these things don't make doctors and nurses actually wash their hands!  What actually works?  A combination of lots of education and reminders as well as shaming people. 

What about making doctors think more about the harm they may be doing their patients?  This study seems to suggest that it may help:

Or how about this idea, the Big Brother approach:

Do you have any ideas for how to improve hand hygiene at BSMMU?  Send them to me?  Want to design a poster or badge, that would be great.  I will get it translated in to Bengali.  Want to design an information sheet for parents telling them how and when to wash their hands, that would also be great!

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