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Cultural Considerations for Hand Washing

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Cultural Considerations for Hand Washing

Global Health

Cultural Considerations for Hand Washing

Cultural Considerations for Hand Washing

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The World Health Organization is issuing new recommendations telling doctors and nurses how to wash their hands. Some of steps seem common sense, but cultural considerations made the guidelines more difficult to agree upon than one might think.

ALEX CHADWICK, host:

More science news, though it sounds more like the advice mom gave you: Wash your hands. The World Health Organization is releasing a new set of standards for hand hygiene. These are hand-washing instructions for doctors and nurses and other health-care workers around the world. Too many of them are not doing it correctly, and they are spreading infections. That's true in remote clinics in the Third World outback and in shiny city hospitals in downtowns everywhere. Everyone needs to do better, though, as NPR's Joanne Silberner reports, that's more complicated in some places.

JOANNE SILBERNER reporting:

Dr. Didier Pittet is a zealot about hand hygiene, regularly working late into the night on programs to improve cleanliness in hospitals, clinics and doctors' offices around the world. It's because of one number.

Dr. DIDIER PITTET (Director of Infection Control, University of Geneva Hospitals): At any point in time in hospitals, and I'm talking hospitals only, over 1.4 million people worldwide are suffering from infections acquired because of health care.

SILBERNER: Pittet's director of infection control at the University of Geneva Hospitals, and one of the prime movers behind the World Health Organization's new guidelines. He says the problem of health workers with unclean hands may be more common in the developing countries, but it occurs all over the world.

Dr. PITTET: The average infection rate in these so-called modern hospitals will be between 8 and 12 percent of all hospital admissions. Now in a hospital where you have no infection control program or an infection control program that is poorly working, of course, the infection rate is higher than this, and it could be as high as 15, 20 percent.

SILBERNER: Infections caused by health-care workers cost the health-care system a lot of money.

Dr. PITTET: In the United States, the estimates are between 4.5 and $5.7 billion US per year.

SILBERNER: Pittet and the WHO say the answer's not in hand-washing with soap and water; it's instead 20 to 30 seconds with an alcohol-based hand rub.

Dr. PITTET: You need to change the system. So the system change is to make alcohol-based hand rub available at the patient bedside.

SILBERNER: Everywhere, he says, not just in some places like today. But the alcohol-based hand rubs have two potential problems. One is the perception that if they're used many times in a day, it will dry the skin. Pittet says most of the new alcohol rubs have a moisturizer, and anyone who finds them drying can use an additional moisturizer afterwards. The second problem is one that came up in the United Kingdom, where the hand rubs are widely used. Some Muslim health workers objected to the alcohol in the rubs. Dr. Ziad Memish was on the WHO committee. He explains.

Dr. ZIAD MEMISH (Infection Control Expert): It's known in the Islam religion that alcohol is forbidden to be drunk, but unfortunately they confuse drinking the alcohol with using the alcohol topically on the skin.

SILBERNER: Memish is a Saudi Arabian infection control expert. He researched the issue and found a description of a group of eminent Muslim scholars who met in Mecca in 2002 who considered the issue and said it was OK. Memish says he doesn't anticipate major concerns with the new guidelines. Alcohol-based hand cleaners have been used in Saudi Arabian hospitals for at least three or four years, and no one there has complained. Joanne Silberner, NPR News.

CHADWICK: I'm Alex Chadwick. NPR's DAY TO DAY continues.

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