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An Eye For A Hand
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
B
ig Brother is watching - but
sometimes, not the right
things. I have long thought
computers that monitor our
every move: the Fitbit that sup-
posedly counts every step (but not biking
or swimming), the endless quest for the
current password, the electronic signatures
that document our digital presence in any
record at all times, are more trouble than
they’re worth.
But a recent article by Lisa Ward in the
Wall Street Journal of May 29 might be
changing my mind. She cites the work of
researcher Dr. Arnold Milstein, professor
of medicine and director of the Clinical
Excellence Research Center at Stanford Uni-
versity. He and his colleagues have been
studying whether computer technology can
help detect if people like us actually wash
our hands before and after we touch the pa-
tient. Since the CDC has said that one in 25
patients can develop a health care associated
infection, and the recent epidemic here of
hepatitis A has raised everyone’s awareness
to some degree, now is a good time to worry
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more about this.
The researchers in these studies have
installed sensors that generate identi-
ty-blurred video that confirms whether or
not someone has stopped at the hand san-
itizer station just inside the patient room.
Per Ms. Ward, they collected thousands and
thousands of images of people sensed by
the device above the hand sanitizer, and
taught the computer program to recognize
when they had used the sanitizer and when
they had not.
The algorithm was then applied to an
ICU in Salt Lake City at Intermountain
Healthcare, and when images generated
by its own computer system were used, the
accuracy rose to 98 percent in identifying
who sanitized and who did not. So far they
have not worked out exactly how to tell if
someone washes her hands at the sink, or
not. One odd thing that Ms. Ward noted
was, “The idea is to see if current practices,
like washing hands after touching a patient,
effectively fight harmful and drug resistant
bacteria or if different steps are needed.”
What different steps? Right now, Ebo-
la has come back with a vengeance in the
Congo. Dispatches from the doctors, scien-
tists and nurses there so far are reporting
cautious optimism. Instead of starting from
ground zero with this dreaded disease that
kills the caregivers first, the medical teams
are starting from a strong knowledge base.
They have learned the lessons of caring for
patients with Ebola in the most costly and
terrible way, so now they have protocols,
logistics, equipment and manpower needs
well calculated. They have been able to strike
hard and fast this time. After a rural bishop
traveled over 100 miles by foot, boat and
motorcycle to report the current outbreak,
teams in the Congo were activated within
hours.
When I review all of the guidelines for
personal hygiene and personal protective
equipment use for prevention of the spread
of Ebola and the protection of all caregivers,
every drop of information says that hand
washing and/or hand sanitizing are essen-
tial. Because of the particular struggles of
obtaining proper equipment in poor places
in rural Africa, the World Health Orga-