Lior Zoref

Crowdsourcing advocate, @liorz


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How can we make a behavioral change among medical personnel so that they’ll wash hands before examining each patient? It can save many lives

Here’s a question that might help save many lives.

Hospital-acquired infections are causing 100,000 deaths each year in the US and many more around the world. This is one of the biggest challenges in hospitals today.

Much of the ‘blame’ rests on the hospital staff, since these infections are transmitted far more often when hospital personnel fail to regularly wash hands and practice proper hygiene.

Hand washing is the single most important measure for reducing the risks of transmitting infections. Yet the harsh reality is that too many physicians and nurses, including those in the most advanced leading medical centers, do not bother to wash hands regularly although an antiseptic gel is accessible near every patient's bedside.

Many hospitals tried to take disciplinary enforcement measures but it doesn't seem to help. There's also a solution based on electronic systems (with RFID tags) but it's too expensive and complicated to implement broadly.

I’m working with Prof Gabi Barbash, CEO of Tel Aviv Sourasky Medical Center, in order to try and find a creative idea that might solve this problem.

Try to think of an idea that can make a behavioral change among the medical personnel so that they will all wash their hands before and after examining a patients.

Maybe together we’ll find an idea worth spreading to stop infections from spreading…


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    Nov 24 2013: Hi Bart,
    Current research shows that most infections are transmitted by the medical personnel. Antiseptic gel or spray is widely available near every patient's bed but still hospital personnel fail to regularly wash hands before each patient.
  • Nov 24 2013: Let me raise some other questions about hospital acquired infections (nosocomial infections).
    1. The infection could be spread from the patient to other people than the attending physician, such as nurses, food handler, visitors or even the patient himself if he can walk around in the corridor or the common area.
    2. There could be some airborne bacterial or viral agents.
    3. In the U. S. I believe that lot of physicians use surgical gloves to touch the patient, then there are less need to wash hand. On the other hand, physicians frequently use portable computers to retrieve patient data or enter new data, so if that is the case, s/he has to wash multiple times to observe a single patient to avoid the contacting infective agents through the computer keyboard.
    4. Many clinics have antibacterial spray or pumps available in patient visit rooms, but I am not sure the health care staff use them that often.
  • Nov 22 2013: I find it interesting we are still discussing this topic after over 100 years after Pasteur and Lister argued for medical personal to wash their hands.
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    Nov 20 2013: zior, one bad thing about washing your hands is the lye in the soap strips the oil out of them. I would like to wash my hands more often, but I don't do it for this reason, my hands feel dry
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      Nov 20 2013: Interesting point. We'll check that with the medical staff to see how they relate to this point.
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        Nov 20 2013: some people will say to rub oil into your hands after each handwashing. I have never trusted this as the external oil does not seem as organic and healthy as the natural oil produced by your body, present everywhere including one's hands. For me this would not be a solution.

        I do try to keep my bathroom clean which is something I can do without stripping hand oil.

        One thing I hate about a public men's bathroom is how noisy most guys are. For instance, when they close the door to the stall, they bang the door shut. If they have to put the lid down on the toilet, they tip it a few inches and then let go, so it crashes down. Are men in Israel the same way?
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          Nov 20 2013: I'm not sure about noisy people are at the men's bathroom but generally speaking, I think we're a bit more noisy then other nations :)
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        Nov 21 2013: your nation is a bit more noisy in what way, Lior? I'm talking about people handling something too roughly that isn't even theirs, in my mind continuing small acts of vandalism.

        I always say treat other people's property as if it is your own.

        Have you inquired about whether people avoid handwashing so as to not chap their hands? Let us know the results.
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    Nov 20 2013: Additional remark:

    Antibacterial properties of metals does not cause immunization of germs, as its working principle directly attacks their enzyme transport and cell membranes, which, so far, are not known to be able to adapt to it.
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    Nov 20 2013: Idea #2: Make hands less receptive to bacteria

    Certain metals, such as Copper and Silver are known to have antibacterial properties.

    Also known are so called 'invisible gloves', which are actually noting more than a certain type of hand cream, which is composed in a way to fill in the micro-structure of our hands, so that dirt won't get down to it and to stick easily. I used this invisible gloves myself, especially while working with soot and/or oily substances, and the result are dirty hands which are way more easy to clean than without the use of this hand cream before.

    The idea now is to combine both - the antibacterial properties of silver in form of nano particles with a similar hand cream to fill in the micro-structure of our hands to form a longer lasting and also active as well as constantly spreading disinfection barrier.

    The first positive effect this 'invisible disinfection glove' will have is to reduce the surface area of the skin of hands, by filling all the micro structures and pores with antibacterial silver particles enriched cream, so that bacteria won't be able to settle 'down there' and those who manage to get there won't survive long due to the silver.

    Secondly, the remaining surface of the hand will mainly be antiseptic, again by the silver particles, which persistently settle within the micro-structures and also constantly smear across it.

    Thirdly, and positively, the 'invisible disinfection glove' constantly wears off and this as well at exactly those objects, which are known as general 'germ hubs', such as door handles, water tap valves and toilet brushes and will therefore constantly ensure collateral disinfection throughout the day by all medical personnel.

    Yet careful, this idea is just an idea and has not been dermatological tested yet. Also important is the nano particle factor here, as this technology is still new and still on 'the hype', which, at times makes, researchers less careful regarding side effects at daily use.
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    Nov 20 2013: What about a small bracelet (or finger ring) which each medical person has to wear while at work. Within this bracelet (ring) is some simple electronics, which sets of a signal tone which can only be stopped by placing a water droplet on a special evaporation pad within this bracelet (ring).

    While the pad is moist, it conducts a gate current to the electronics, which in return holds back the signal tone to that point, when the pad moisture drops below a critical conductivity by natural evaporation. Once the pad is to 'dry', the signal kicks in and reminds the medical person to 'wash hands' and to refill the bracelet pad with a new drop of water.

    This way there is a constant need to return to a sink to bridge our given human forgetfulness, and, once there, to also wash hands.

    Given the fact, that most hospitals run under almost constant climate conditions throughout the year (more or less), the evaporation rate of water would be almost the same. But if necessary, the critical conductivity could be made adjustable to control the 'time in between signals' to a given medical environment, hygiene criticalness or simply the regular seasons.

    The use of saliva to 'refill' the pad has to be strictly prohibited and violations prosecuted, as otherwise the whole concept can and will be bypassed by some. And as the evaporation pad itself has to be replaced from time to time out of hygiene reasons, there might be some random tests conducted on them to trace for certain bacteria which only come in saliva yet not in usual drinking water (if there are any bacteria of this sort, which I assume yet simply don't know). Given the fact, that this evaporation pad will sooner or later get in contact with disinfection fluid as well, these tests probably won't run on usual cultivation methods for detection, as, if not by total dryness alone, no bacteria would likely survive then. But maybe other methods are thinkable to check for 'illegal spitters' which detects death bacteria as well.
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      Nov 20 2013: Hi Lejan,

      Very innovative idea. But the fact is that any solution which is technology oriented will be expensive to roll out on a large scale. This is why we need to think about an idea that can change behavior without expensive technology.

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        Nov 20 2013: In other words, the budget is low - if any - yet the goals, expectations and spirits are high ...

        Then, I am afraid, there is no solution at all, because the 'knowledge' about how to do things right in medical hygiene is already there and no better argument than 'not to kill your patients' can be given to a professional healer.

        And as signs and notes are not working either - even if they were numerous, in signal colors or large in size, not to mention, that they come with a price too, the only remaining option I could think of is to actually ask the medical personnel themselves why they are not doing what they should do.

        Your question reminds me on a project I once worked on about 'quality improvement measures', which - as usual and of course - should come with no investments whatsoever, yet should reduce the given yield by 95%.

        I didn't know about the 'no costs please' at that time and wouldn't have started if I knew.

        Many hours of investigations, meetings, power point presentations and number juggling later the result was clear:

        Inefficient strategy, inefficient machinery, inefficient number of workers

        Solution: Change strategy and invest in modern machinery and more workers

        Reality: Nothing changed by same expectations to reduce the yield by 95%

        Achievements: None, since ...

        So good luck to save 100,000+ lives each year with the given restrictions ...
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          Nov 20 2013: Lejan,

          I didn't say that there's no budget. Hospitals are willing to invest money as it's a very important issue. Yet, in the health services area there's always very limited resources. A solution which is based on behavioral change has a better potential to be implemented on a large scale.

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        Nov 20 2013: It is interesting, isn't it? Given the fact, that the 'health services area' is one of the most profitable areas to run a business in, it seems always very limited on resources. May there be a connection?

        Forgive my sarcasm, yet after years of hearing the 'same story' all over the place I just can't take anyones intentions seriously anymore to get a lot for nothing by just tweaking on secondary details.

        Honestly, what sort of low cost 'conditioning' do you have in mind to change the behavior of skilled, knowledgeable and specialized people who work in that business?

        From my perspective, as a patient that I recently was, it seems to boil down to the same dilemma you can see almost anywhere:

        Too FEW personnel has to cope with TO MUCH and increasing loads of work - and this - CONSTANTLY!

        The basics of project management is the COST - TIME - QUALITY relation, which you can find in any related literature, yet somehow it never made it into the heads of decision makers.

        Given your comment on 'limited resources', which are COSTS and my observations in 'workloads', which is TIME - what does those two restrictions do to the remaining QUALITY, of which hand disinfection is part of?

        The only way it can go is DOWN if TIME goes down too an COST stays.

        Seen from this perspective it makes even sense to 'safe time' by not washing hands over and over again, as its possible although lethal result stays somewhat untraceable in the whole process and can not be linked back again to its original cause.

        So its a bit like radioactivity. One knows it is dangerous, yet as it is not detectable by our senses, we tend to underestimate its risks even though we know about it.

        This is why I encouraged you to actually ask the medical personnel directly to get to know the reasons why they are not doing what they are expected to do and about they know they should do.

        It may take some time to win their trust for them to be open about it, as some may fear to risk their jobs in doing so.
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          Nov 20 2013: I'm not sure I agree about your statement about profitability. At least not where I come from which is Israel. We're dealing with a public health system which is always under budget by the government.
          Yet, you are absolutely right that we need to understand this problem better by asking metrical personnel and trying to understand the underlying reason for non compliance.
          Thanks for taking the time to write in such detail. I appreciate it very much.
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