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Learning from the 20th President

By Dr. David C. Pate, News and Community
November 26, 2013

Who could have known that an assassin by the name of Charles Guiteau and his victim, U.S. President James Garfield, would have something to teach us about the care of patients today from a shooting that occurred in July of 1881? 

Guiteau fired two shots at President Garfield at extremely close range. One bullet grazed Garfield’s arm, but the other was lodged in the president’s abdomen. He was rushed back to the White House where 16 leading physicians gathered to aid in the treatment of the patient. Most of these physicians probed the wound feeling for the bullet or bullet fragments with their uncovered fingers or unsterilized instruments; all were unsuccessful in their effort to recover the bullet. 

President Garfield subsequently developed a fever, a clue to the infection that would ultimately be the complication that would cause his death. He died two months and two weeks after the shooting, not from the bullets fired at him, but from the infection introduced by his caregivers.

The association between germs and disease was not yet understood. Surgery was routinely performed without surgical gloves, gowns, masks, head covers, sterilized instruments, and antibiotics, and without the benefit of anesthesia.

Decades later, we would come to understand the risk for causing infection in patients by germs carried on our hands and instruments. However, more than a century later, still not all caregivers wash their hands each time between patients. The failure to wash hands can cause devastating infections even in a day when we have many antibiotics, unlike the late 1800s and early 1900s. 

It is imperative that we hold ourselves and each other accountable for this and that we empower patients and their families to inquire if we have washed our hands if we did not do so in full view of the patient and family.

Here is a continuation in our blog series of initiatives being undertaken by SELECT Medical Network, our clinically integrated network of physicians, by SELECT Communications Coordinator Chereen Langrill:

When someone is admitted to the hospital to be treated for an illness or for surgery, that person puts their trust into the caregivers at that hospital. There is an expectation that everyone caring for a patient will take every precaution necessary to ensure that person is safe.

And while there is a strong sense of responsibility surrounding patient safety, there is always room to do more. The World Health Organization has said that 247 people in the United States die each day as the direct result of a healthcare-related infection. That is similar to an airplane crashing every day.

Hand washing is one of the most basic skills we learn as young children. It is the best defense against the common cold and viruses, and for patients in the hospital, it is a critical part of care and safety.

Our hand hygiene initiative aims to remind and educate providers and others about proper hand-washing technique and the reason this simple task can make such a significant difference.

Why is it important?

Organisms can live on the hands for up to 60 minutes and on inanimate objects for days or even weeks. The consequences of poor hand hygiene can be the difference between life and death.

As Dr. Pate has noted, President Garfield was shot by an assassin, but it wasn’t the bullet that killed him.Garfielddied three months after he was shot because of a severe infection he contracted through the medical team that treated him. That team did not wash their hands properly.

Within St.Luke’s, the Garfield Project (named for our 20th president) was created to increase hand-hygiene compliance within the Boise critical care units. That project has ended, and other efforts are now under way withinSt. Luke’s to continue the important work the Garfield Project began.

In addition, there is a focus on the hand-hygiene initiative that extends beyond the walls of St. Luke’s, to help all providers and caregivers apply best practices to achieve the same goal: To stop the spread of illness and prevent infection through proper hand hygiene.

What is the challenge?

The ripple effect of poor hand hygiene can be staggering. It takes just one person to endanger a patient by neglecting hand hygiene. Every caregiver, including volunteers, working in a patient environment must follow the same procedure.

Consider these numbers from across St. Luke’s Health System:

  • 600 volunteers
  • 700 physicians on staff
  • More than 10,164 employees
  • More than 34,500 surgical procedures performed each year
These numbers represent countless patient encounters and contact with areas where patients are located. And those numbers are just within St. Luke’s. Imagine how many patient encounters occur throughout our communities.

Each time a surface is touched or contact is made, there is a chance that illness can spread, or it becomes the opportunity to prevent the spread of illness by observing proper hand hygiene.

While hand-washing plays a major role in hand hygiene, it isn’t the only component. Hand sanitizer and gloves also limit the spread of germs.

Encouraging people to practice proper hand hygiene can be a challenge for many reasons, including:

  • A hand hygiene dispenser isn’t visible, is empty, or is broken.
  • Someone has their hands full and doesn’t put items down to wash or apply hand sanitizer.
  • There is a misconception that when wearing protective gloves, there is no need to wash hands.
  • There may be a concern that frequent washing and/or use of hand sanitizer causes dry skin.
What is the goal?

The goal is to use standardized techniques for hand hygiene to minimize the spread of infection and increase patient safety. Increased awareness and education make this practice more likely to be successful. This will take a commitment from each person involved in the healthcare community. This includes every person who may come in contact with a patient or a patient area.

How will it make a difference for patients? What changes will they see?

Hand sanitizer dispensers are located in common areas, near restrooms, and in meeting rooms within St.Luke’s. The goal is to make it easy to follow steps for better hand hygiene by making products such as hand sanitizer readily available. It also lets patients know that we take this effort seriously.

Physicians are encouraged to explain to patients why they wash their hands when entering and exiting patient rooms. It helps patients understand the importance of hand hygiene, shows them what providers are doing to keep our patients safe, and helps patients feel confident in their care environment.

What are the next steps?

We will continue to focus on the importance of hand hygiene within SLHS and throughout SELECT Medical Network of Idaho, Inc. Information will be shared with SELECT providers, along with insights around how patients view hand-hygiene habits.

What’s the measure of success?

By reducing barriers discussed earlier (making hand sanitizer dispensers readily available, for example), we expect that hand-hygiene habits will continue to improve. Compliance will be measured within SLHS and tracked throughout the SELECT Medical Network. The success of this initiative will also be measured by a reduction in healthcare-associated infections, ultimately making it safer for patients who seek care from providers or hospitals.

Click here for a fun video with a serious message about hand washing.

Editor’s note: This is the eighth installment of a 10-part series introducing clinical integration initiatives that St. Luke’s is involved in.

Clinical integration is a term used to describe health care providers working together in an interdependent and mutually accountable fashion to pool infrastructure and resources. By working together, providers develop, implement and monitor protocols, “best practices,’ and various other organized processes that enable them to furnish higher quality care more efficiently than could be achieved working independently.

St. Luke’s Health System is a participating provider in the SELECT Medical Network of Idaho, Inc. SELECT is a network of healthcare providers in southwest Idaho that is focused on a coordinated model of care delivery focused on providing enhanced quality and better value to individuals, employers, and insurers.  

In keeping with the clinical integration effort, 10 initiatives were developed for 2013 to help establish the standards of enhanced quality meant to help create a new vision for health care.

The initiatives are:

  • Diabetes
  • Tobacco treatment
  • Back program
  • Advance directives
  • Patient-centeredness
  • Care management
  • Medicine reconciliation
  • Hand hygiene
  • Pharmacy optimization
  • Shared analytics

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.