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