Louisville Medicine Volume 66, Issue 2 | Page 37

OPINION DOCTORS' Lounge nization (WHO) developed an extremely low-cost hand sanitizer formula based on sugarcane, which costs pennies instead of thousands for the commercial product. The guidelines for Ebola in Africa therefore list hand sanitizing as the ideal. Since the time of Dr. Ignaz Semmelweis, handwashing has been an absolute require- ment of good patient care. Of course, Dr. Semmelweis was only following the lead of the midwives. In 1847, when he proposed to fellow physicians that they should wash hands with a chlorinated lime solution, the obstetrical wards at the Vienna General Hos- pital obstetrical clinic had three times the maternal mortality of the midwives’ wards. Despite publishing his results showing that maternal mortality had fallen to below one percent, he was ridiculed and reviled, and no one in Vienna or Budapest ever paid him the slightest bit of respect. In the late 1850s, he fell into a severe depression, and became demented possibly due to syphilis. In 1865, he was sent to an insane asylum where he died after two weeks at the age of 47, due to sepsis after having been beaten by the prison guards. Almost immediately, the wards he had formerly run had big spikes in the rate of maternal mortality. Not until after Louis Pasteur and the work of Sir Joseph Lister, who championed surgical sterility and was also mocked by his colleagues, was the work of Dr. Semmelweis h onored. I see people all the time wearing gloves for various routine patient contacts. I would like to post this WHO sign on all the wards: Gloves that go on over contaminated hands come off contaminated hands. In a study from England, a model domestic kitchen was set up. Researchers found that in one third of food preparation sessions us- ing Campylobacter-contaminated chicken, the Campylobacter could then be isolated from prepared salads, cleaning materials, and food contact surfaces. Only 500 organ- isms can result in human illness. When volunteers touched lettuce after having their fingers contaminated with a nonpathogenic virus that was a surrogate for the Norovirus, after only 10 seconds up to 20 percent of the virus was transferred to the lettuce. When the viral surrogate for hepatitis A was used, an estimated 300 viral particles were transferred to the lettuce per finger. Thirteen of 14 adults became infected with rotavirus when as few as 10 particles were transferred, and the same was true for the dreaded Norovirus and for the patho- genic E. coli 0157. So, don’t be telling me that you wear gloves, unless you are operating or doing a sterile procedure. On the other hand, you can video me at the hospital sink all you want. However: if you are feeling too lazy to wash your hands, go back and review the estimated viral loads likely to get you a hor- rible three days or weeks of diarrhea. Only 10 particles of Norovirus: it’s not Ebola, but it’s still a nightmare. Dr. Barry practices Internal Medicine with Norton Community Medical Associates-Bar- ret. She is a clinical associate professor at the University of Louisville School of Medicine, Department of Medicine. The use of gloves does not replace the need for cleaning your hands! JULY 2018 35