Saturday, January 26, 2008

Keeping it clean in midwifery practice

[Image: wash away your sins; from Carol Esther's photostream at]
I am becoming increasingly concerned about recent news reports about problems which relate to health professionals not performing adequate hand hygiene. I teach in a midwifery education program and we have a strong focus on universal precautions and in particular performing good hand hygiene. We are soon to have a new intake of midwifery students into our school and so this topic is at the forefront of my thoughts at the moment. So perhaps I am just being super-observant about news items on this topic. None the less it is concerning that the message about hand hygiene does not seem to be getting through to health care workers.

The first item that caught my attention in the last few days was a new item from the Center for Disease control in America.This talks about the prevalence of Cytomegalovirus during pregnancy. Although in the normal population this virus does not have any major health concerns it can have serious implications in pregnancy. Prevention of spread of this virus is through good hand washing, particularly after changing nappies of babies and young children. This is such basic common sense information and we, as midwives have a duty to make sure that we tell women about the importance of this and demonstrate the importance by always washing our hands after changing babies nappies ourselves.(Photo: Fresh air change; from Kongary's photostream at

Today, in the Scotsman newspaper Clostridium Difficile is becoming resistant to Metronidazole, which leaves only Vancomycin as a viable treatment option for this bacteria. This is a enteric (bowel) bacteria and once again it's spread is controlled through good hand hygiene. A quote from this article "Margaret Watt, chairwoman of the Scotland Patients' Association, said: 'We need to bring back ward matrons who are responsible for ward cleanliness and staff who are found not washing their hands should be given a written warning.'" "Health Secretary Nicola Sturgeon said: "We expect all health boards to have robust policies in place to help manage C diff. These should include monitoring of compliance with cleaning standards, infection control precautions, prudent prescribing of antibiotics and rapid, accurate diagnosis of cases."

We have known about the importance of hand hygiene for a very long time. In 1847 Ignaz Semmelweis found that hand washing reduced the instance of puerperal fever. Yet still we have regular news stories about poor hygiene practices leading to iatrogenic infection illness and death. Lately there has been the introduction of hand cleansing gel and this has greatly improved compliance with hand hygiene practices amongst health professionals. However in this study, even with the improvements compliance was still only about 50%. We need to do better.


Sitting in Silence said...

I totally agree but not only in the health settings, also in daycares and schools.

I spoke to my childrens school principle after an outbreak of D&V last year.

It was a huge outbreak with both teachers and whole families becoming infected.

I believe simple handwashing would have broken the chain of infection.

After all it's the single most effective prevention againist disease...

My profile said...

Thanks for your comment Danielle. It is very concerning that despite the focus that is put on this in education, in schools as well as for health professionals, the message is still not getting through. I think this is because, no matter what is taught, it is not being modeled in practice. So we have a responsibility not just to tell people about it but to make sure we always do it properly ourselves.

Bill said...

I found some interesting facts about Cytomegalovirus here. Check it out!

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