So how do we fix this problem? It is obvious that if we were able to reduce that forty percent figure, we would be able to achieve greater productivity in hospitals and other areas associated with health care.  More lives would be saved faster, and we would be able to make room for more patients.  Not only that, but we would be able to reduce the risk of things like international pandemics, since doctors would be exposing people they interact with to less harmful pathogens.  Basically, the gist of it is that less people would get sick, which is unambiguously a good thing.  There are many organizations dedicated to increasing the world’s health, like the CDC and the WHO, but it is clear that these institutions aren’t effective in getting their message out to health care providers, people just aren’t listening.  About fifteen years ago, in 2005, the WHO started a world wide program to increase hygiene in hospitals, called “Clean Care is Safer Care.”  As part of this initiative, the WHO tested various tools for increasing hygiene, and even introduced a world health day.  These things have proved largely ineffectual (do you know when world health day is), although it must be admitted that four years later in 2009, it introduced a patient safety initiative through the program that reached about four million health care staff members and provided guidelines and tools for hand washing and public hygiene.  No matter what though, it is clear that we require some change in order to increase our public hygiene.

Some of the things shown to improve personal hygiene of healthcare professionals include: government support and intervention, easy access to disinfectant, simple, in person training sessions in every ward, positive role modeling from senior doctors, indicators for cleanliness.  The bottom line however, is that there needs to be a system in place that is personal to every hospital, sweeping generalized regulations, guidelines, and suggestions have proved to be ineffective in tackling this problem.  Ultimately there needs to be more oversight in hospitals, we need to be able to tell when healthcare professionals’ hands are clean and when they aren’t, and we need to be able to communicate that washing your hands is necessary no matter the situation.  For example, doctors sometimes replace hand washing with just wearing gloves, but this is not effective, pathogens still pass over their hands.  This sort of thing needs to be discouraged.  It will be impossible to create a solution that is 100 percent effective, but we should always strive to optimize our public works, especially things as important as health care.

Hand washing, and specifically soap, is one of the most important inventions of the modern era.  The reason we are able to have such good public infrastructure: like plumbing, public transportation, good quality roads, etc, is because we have public hygiene.  Cities are no longer incredibly unclean places to live, and a fever is no longer a death sentence.  So we see that hand washing is important for almost every element of daily life, but it is most important in providing health care.

Before hand washing, disease carrying agents were often transferred  between healthcare providers and patients.  This was a huge problem, and it often meant that people wouldn’t go to the hospital if they were sick, especially since doctors and nurses come into contact with some of the most disease ridden parts of society.  It was, for a long time, much better to stay home and tough it out, perhaps applying some home remedy now and then, than to go to the doctor unless you were extremely ill.  On everyone’s hands there are two types of microbes: one is resident flora, which live under the superficial layers of your skin, and are actually beneficial to your personal health, protecting you from more dangerous microbes, and the other is transient flora.  Transient flora are microbes that pass over your skin daily, they get to you through people that you meet, surfaces that you touch, and the spaces that you walk through; these are the types of microbes that you don’t want your doctor to pass over to you when you’re sick, that your doctor doesn’t want passed over to them from you, and that are killed when you wash your hands.

Today, we don’t even need to think about washing our hands, it has become such basic practice that it’s almost second nature.  We have forgotten that not so long ago, when soap and clean running water were hard to come by, basic hygiene was a luxury, one that sometimes wasn’t even taken advantage of by those to whom it was available.  Medical institutions are perhaps the most important setting in which hand washing is implemented,  both patients and health care providers are susceptible to infection, especially since they are in constant contact with each other, and hand washing is instrumental to lowering the rates of infection.  In the 1850s, when this practice was not widely implemented, one hospital’s rate of infection decreased tenfold when hand washing was implemented.  The necessity of washing your hands is largely regarded as common knowledge now, but in many communities and, shockingly, in most healthcare institutions, acceptable levels of hand hygiene are achieved at a rate of under forty percent.  This should be incredibly surprising to you, people should be washing their hands in hospitals, and it’s almost outrageous that the standard of hygiene is so low.

In the past 45 years, the CDC and other corporations involved with disease control began to advocate heavily for hand washing.  Importantly, the CDC recommended that health care providers disinfect their hands between every operation with alcohol based sanitizer with 70 percent alcohol, and that they wash their hands as regularly as possible.  But these organizations can only do so much.  They can only really recommend procedures and perhaps raise awareness within the medical community that hand hygiene is really important.  But beyond that, enforcement of hand washing is difficult unless you can watch every doctor and nurse at all times.