By Paul A. Goldberg, M.P.H., D.C., D.A.C.B.N.
In 1847, Ignaz Semmelweiss, M.D. (1818-1865), an Austrian physician was working
in the Vienna Hospital. An independent thinker, Semmelweiss went against the
establishment of his time and promoted a radical procedure: hand washing between
patients. Though Semmelweiss was greeted by fierce attacks on his character
by his fellow physicians, his independent thinking about hand washing eventually
caught on and has become an expected standard of health care.
One might imagine that the lesson that Semmelweiss made clear would hardly need
to be repeated in the 21st century. Yet the facts say otherwise.
The United States Centers for Disease Control and Prevention (CDC) has concluded
that hand washing is “the single most effective way to prevent the transmission
of disease.” The CDC further estimates that 2.4 million Americans acquire
an infection in hospitals each year and that half of these infections are preventable
by proper hand washing. Hospital-acquired infections now cause or contribute
to 100,000 deaths annually.
Patient-to-patient transmission of infectious microorganisms can just as easily
occur in a hospital as a doctor’s office, whether M.D. or D.C. Much of
this can occur through the doctor’s implements and office furniture, particularly
with examination and adjusting tables in the office where disposable paper is
not used and changed after each client. The CDC finds, however, that the majority
of infections are spread from direct touching from a health care professional
to a patient. Logically, the more patients that are seen and touched by the
doctor of chiropractic, the greater the risks for cross contamination become.
The problem persists. In 1996 a study published in the Medical Journal of Australia
showed that only 12 percent of physicians in a pediatric intensive care unit
washed their hands after patient contact. Even after a program of education
and monitoring, handwashing rates rose only to 17 percent. Although embarrassing,
evidence shows that doctors and other health care workers in office practice
frequently do not wash their hands between patients or do so inadequately. In
34 handwashing studies it was seen that health care professionals only properly
washed their hands 40 percent of the time. This shortcoming is often attributed
to hectic schedules. To the patient, however, who goes to the medical or chiropractic
doctor already in a state of compromised health and leaves with the potential
of an infectious problem in addition, a doctor’s “hectic”
schedule may be of little comfort.
But there are simple and effective solutions that all doctors of chiropractic
can employ for the protection of our patients:
Use full-length bench paper on all adjusting and examining tables. If the patient does not remove clothing for their adjustment such that their skin surfaces do not contact the table then face paper alone would be adequate. Change paper after each patient.
Wash hands properly between every patient using soap and warm running water, rubbing the hands together for at least 10 seconds. Pat dry with paper toweling. Turn off the tap using a paper towel.
An alternative to washing the hands with soap and water is to employ waterless hand washes that contain alcohol as a disinfectant. These not only are more effective at cleaning but also do the job more quickly and with the emollients added are easier on the hands. Even the busiest doctor should be able to find time to use these products for between patient cleanups. If not, the doctor is simply seeing more patients then can reasonably be handled safely. It is, after all, not how many patients one can see, but how many one can see and actually help that is important, and it is no help at all if the patient is leaving the office with an infection that they did not have when they arrived.
In our office, we have a sink with running water in every examination room. Doctors setting up new offices might consider employing this idea. I believe there is an extra feeling of security on the part of the patient as well when he sees his or her doctor washing their hands prior to touching them.
We do not have to have germ hysteria to take these simple hygienic steps. Germs are not the cause of all diseases. Healthful exposure to a wide range of bacteria when young and the introduction of friendly non-pathogenic bacteria at all ages can go far in helping promote good health and preventing disease.
About the author: Dr. Paul Goldberg is a graduate of Bowling Green State University
(B.A.), Life College (B.S.) The University of Texas Medical Center Graduate
School of Public Health (M.P.H.), and Life College (D.C.). For the past 23 years
he has been a full time faculty member of Life University as a professor of
gastroenterology, public health and clinical nutrition. Questions and comments
are welcomed and may be directed to drpaulgoldberg@hotmail.com. Further information,
related articles, and links can be viewed at goldbergclinic.com.
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