In 1847, an Austrian obstetrician (Ignaz Semmelweis) figured out that hand washing in hospitals saves lives. On trying to persuade the medical profession of this fact, he came up against considerable resistance, with public ridicule and dismissal from his post at Vienna General Hospital. Nonetheless, in 1861 he went on to publish ‘The Aetiology, Concept and Prophylaxis of Childbed Fever’, and his legacy lives on today as the pioneer of hand hygiene in clinical practice.
150 years have passed since Semmelweis’ seminal work on hand hygiene, and the world today is much more accepting of his findings. It is widely agreed upon that hand hygiene helps in the prevention and control of communicable disease. Nowadays, all healthcare workers receive training about the importance of infection control measures such as hand washing. However, is it always practiced?
In the UK, every hospital bed should have its own alcohol gel dispenser. Every bay in the ward should have a sink and alcohol gel dispenser within it. The entrance to every clinical area should also have hand gel dispensers. Despite such measures, hand washing does not always take place. Time pressures, emergencies and general forgetfulness are just some of the factors affecting hand washing.
In Zambia, the challenges are greater still. A drawback of Nightingale style wards is that the distance from bed to sink can be far. There are only two sinks on the female medical ward. Even if you do go to a sink, you may not find water. We are currently in the hottest part of the dry season, and on most days, we experience several hours without running water. Even if the tap is working, there may not be soap and almost certainly no paper towels.
In a hospital that frequently runs out of essential stock items such as intravenous fluids, insulin and antibiotics, it is not surprising that alcohol gel is not available here. This means that when the water is off, unless a staff member has purchased their own alcohol gel, hands stay dirty.
There is only one side room on each medical ward, so patients that should be isolated due to infective diarrhoea, TB, or meningitis are in bed next to cancer patients, diabetics and immunosuppressed HIV patients. We go from bed to bed, and so do the germs.
One of the challenges I face is trying to bring about improvements without appearing critical or judgmental. Having only been in Zambia for 2 months, I am aware that I am a visitor here, and my observations may be both unwelcome and insulting. There is also little merit to me enforcing changes that I think should be implemented, because without local ownership of the changes, there is a high chance it would all revert back as soon as I leave.
There is plenty of scope for apathy in this situation, but it has never been my style. Although I don’t want to end up shunned like Semmelweis’, I also don’t want to sit back and watch as E.coli, Mycobacterium tuberculosis and Isospora belli do their rounds alongside the clinicians. Any suggestions for tactful approaches?