I just returned from the Healthcare Epidemiology Training course in Ho Chi Minh City, Vietnam, where I had a wonderful time interacting with the students and other faculty. Thanks to Professor Le Thi Anh Thu, we had the opportunity to tour an 1,800-bed hospital in the city and observed many barriers to infection control, including an average daily census greatly exceeding the bed capacity. Many patients are forced to share beds with other patients. However, in one area Vietnam is far superior to the United States; they allow alcohol hand rub at the bedside! You can see Joost Hopman, Andreas Voss and I touring a medical ICU in Vietnam - notice the green hand rub dispensers at the end of the beds.
In the U.S., fire code prevents alcohol hand rub from being placed at the bedside, rendering the practice of the WHO 5 moments impossible. Health care workers simply don't have the time to leave the room to practice hand hygiene after each contact with the environment or patient.
Here is the WHO's take on the fire risk of alcohol hand rubs: ”The benefits of the alcohol in terms of infection prevention far outweigh the fire risks. A study in Infection Control and Hospital Epidemiology (Kramer et al 2007) found that hand rubs have been used in many hospitals for decades, representing an estimated total of 25,038 hospital years of use. The median consumption was between 31 L/month (smallest hospitals) and 450 L/month (largest hospitals), resulting in an overall consumption of 35 million L for all hospitals. A total of 7 non-severe fire incidents were reported. No reports of fire caused by static electricity or other factors were received, nor were any related to storage areas.”
So let's review the U.S. situation:
Deaths from resistant bacteria? 23,000
Deaths from alcohol hand rub fires? 0
Changing state fire codes to allow alcohol hand rubs at the patient bedside? Priceless
Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.