Debra Smith


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Germ warfare: The real battle for survival is with germs not people. BUT People keep transmitting germs - how can we reduce transmission?

The 4th leading cause of death in North America is a disease you acquire when your are IN a HOSPITAL. The total number of deaths surpasses all deaths from murder and traffic accidents combined!

Why should hospitals make people sick when we know how to prevent transmission of disease? With more and more infections becoming resistant to antibiotics how do we convince people to do the simple things like washing their hands?

The main question here is how can we encourage hospital staff to clean their hands (actually studies indicate that they are doing it only 30% of the time when they should)?

The complicating factors include:
The highly stressed environment in which many medical personnel work where time demands are great (thus they feel that they do not have time to wash or use alcohol rub).

Patients feel vulnerable and do not feel empowered to ask medical professionals to clean their hands before touching their bodies.

Incremental cost increases in using more product and the time cost of use.

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    Jul 6 2011: I think we need to reinforce, even force hygienic behavior at hospitals, even if the personnel feel like they don't have time It's actually costing them more time not to do so, making them understand this may be crucial.

    Maybe getting doctors and nurses to join this conversation is a good start ;)
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    Jul 7 2011: Well that is a scary statistic. It seems like doctors are to busy fighting disease to spend much time helping people. Every time I am in a hospital I'm always taken back by the lack of fresh air as often windows are sealed leaving air conditioners to circulate recycled air over and over. I'm would not be surprised if some bacteria were tolerant to bleach at this point.
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      Jul 7 2011: I felt the same thing here Anthony.Hospitals are a place to heal people ,not make them ill.Seriously, they need to figure these things out before things gets worse.
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      Jul 7 2011: Anthony, You make some important points here. Many hospitals need to be redesigned. Air exchange is vital. Many hospitals are old. Some of the transimssion rates are tied to the number of private rooms. For example the better concept is one patient one toilet and one bed per room. Even things like the drapes between beds can be seriously contaminated. While I haven't read anything about bacteria tolerating bleach, I am firmly aware that bleach is harmful to the healthcare workers who use it. There are products out there that use forms of vinegars, octanoic acid combinations that are far less hurtful for human beings and even kill diseases which revert to spores and thus are able to hide in cracks of matresses and window sills etc. This is a world wide problem.
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        Jul 7 2011: Well I was just hypothesizing on the bleach, but hospitals can be pretty gross non the less. I also have to question the diet of processed food most patients are on. It may seem like a little thing, but when dealing with people who have compromised health a diet high in fruit and veggies low in more inflammatory foods such as dairy is a great way to boost the immune system in a pond wise penny foolish manner.
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    Jul 8 2011: Correction: It was Dr. Semelweis who discovered that doctors moving from autopsy to maternity for deliveries were killing the young mothers. He used a special soap because other types did not even remove the smell.

    What ever happened to the old adage: Cleanliness is next to godliness?
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    Jul 7 2011: For your own immune-system's sake, don't sanitise, just wash.

    Population will need to be curbed at some point. Funny how nature irons things out..
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      Jul 7 2011: Yeah, let's not forget about "the hygiene hypothesis" !
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      Jul 7 2011: It goes back to Dr. Lister who discovered germs. I think if I remember history correctly, they realized that they were killing off mothers who had recently delivered babies by bringing their unwashed and contaminated hands directly from doing autopsies.

      While I agree that we should not be using soaps with ingredients like triclosan, It is an error to disuade people from sanitizing their hands. The recent research indicates that alcohol kills every germ it contacts while wet on contact and leaves none wounded to continue and gain resistance. It your hands are not obviously gritty or soiled, hands are better off with alcohol gels (it kills all the germs and it preserves the skin). In places like Canada where the weather gets cold the ingredients in soaps 'defat' the hands- meaning it draws fluid out of the tissues and it along with rough towelling causes microabrasions which allow the entry of germs. YIKES! When exposed to the further damage caused by cold weather, hands become reservoirs of disease (and they start to hurt making it less likely that people will clean their hands.
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    Jul 6 2011: "BUT People keep transmitting germs - how can we reduce transmission?"

    Simple eliminate people. No people - no transmission.
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      Jul 6 2011: Haha, I though the same thing but it didn't seem to good to say it out loud! :D
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      Jul 6 2011: That is probably an example where intellect goes wrong... ;P
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      Jul 6 2011: maybe i can recommend you this cute little website
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      Jul 6 2011: Richard and Jimmy......Funny...I am sure ya'll are kiddin' My hospital and doctors' offices post signs all over the place telling patients to demand that their personnel use germicides. They say don't be afraid to speak up. I think that's great 'cause that is where most of the transmission occurs.
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        Jul 6 2011: At least I was...
        A bit of dark humor isn't that bad every now and then is it?
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          Jul 6 2011: is good for the soul (:>)
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        Jul 7 2011: Helen, That is great to hear. What hospital is it?
        The idea that we need to make clear to all people is that they not only have the right but the responsibility to demand that healthcare staff clean their hands. Some of these conditions are painful and life threatening. In my area a year or two ago 60 people died in one hosptial from c. difficile. The news papers ran a profile a day of each person to increase awareness.
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          Jul 7 2011: Debra............The name of the Hospital System is Scott & Temple, Texas.
          It is considered the Mayo Clinic of the south. It is a teaching hospital, hosting the Texas A&M School of Medicine. There is also a big VA Hospital. Each year the church I attend devotes one Sunday to honor the people who work in the medical field. They ask the medics to stand up and half the congregation stands. It is one of the biggest employers in Temple. They really try. Every nook and cranny has germicide available.
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      Jul 7 2011: Okay you guys! Love the humour but how do we get people to take this seriously?
      Any ideas on how to get people to seriously enact the hand washing policies?
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    Jul 27 2011: Thanks so much for sharing this Jimmy!

    Here is an important excerpt that outlines some of the problems associated with this work:

    Several reasons may explain why a simple checklist protocol is not more widely adapted:
    Many physicians do not like being monitored by nurses or otherwise being forced to follow a checklist;
    A wish to avoid standardized tasks and bureaucracy; and
    A focus by researchers on "more exciting" issues such as disease biology and new treatment therapies.[12]
    According to Pronovost:[6]

    The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is ensuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.
    An internationally recognized expert on hospital safety,
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      Jul 30 2011: Always glad to help!
      I'm not going too deep into this yet Debra but I'll be thankful for any and all info or plans that you've got so far!
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    Jul 27 2011: Hi Debra!
    Some days ago I read about this doctor Peter Pronovost, with some simple steps he has managed to drop infection rates in some hospitals in the U.S from 11% to 0!!!
    I'm heading out right now and I probably won't be online for a day or two so I just wanted to share this before I left, I really think that it's worth looking deeper into this!
    Here's the Wiki to get you started!
  • Jul 27 2011: A,A:they should not B,A:you must eventually integrate the hand washing into the human cultural psyche first,by(in my opinion)just like the car was eventually integrated as well as physics,modern medicine and computers ect."but integration cant take place without a little frustration" C&D,A:BY intergrating lights(of a certain wavelenght or germ serilization lights (like on the sonicare toothebrush holder) at the enterance of patient room doors and or operation room doors(in order so that they can actually see the germs on their hands)(or the germs might actually be killed when hands are held over the lights for a few seconds)E,A:Germ exposeing lights to show patients the germs(because seeing is believing right?)F,A:This problem might be solved by,Recycleing broken or outdated medical equipment,less waste of stocked supplies,not having to pay large ammounts of money for equipment as a result of(the hospital knowing that they have it)(and the companies knowing they will pay it)These are just my opinions nothing more.
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    Jul 9 2011: Debra, we live in germ filled world even our own body system is full of germs. But we don't get sick always because of that. Because all germs are not harmful but some definitely are. Even those harmful germ can't do any harm until our immune system is weak enough.

    In hospital , people stays when they are sick , so they are vulnerable both to their own germs and germs other patient. Yes washing hands and taking other preventive care will help but it can't stop it full because germs can transmit through other media as well , like air, water etc etc.

    One interesting observation is that people who lives in natural condition or even a bit poor hyginic condition are more protected from germs as they have already developed some immunity in natural way when they were healthy , so they don't immediately fall victim. More sterile environment we live .. more susceptable we are to germ.... well I am not telling that we all should live in unhygenic condition by saying that .... just mentioning the observation.

    Major challenge is how we really can keep hospital environment more sterile. The resistance to antibiotic is a big challenge , because of the abuse and poor compliance to antibiotic therapy that gives opportunity germs to mutate for the safeguard of own life.... which is a natural instinct....

    Moreover no significant R&D is going on in this area due to different , commercial and regulatory reason.......

    It's really a subject of significane you came up as usual
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    Jul 7 2011: its the .1% that surives the 99.9% from antibacterial soap.
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    Jul 7 2011: .
    The reverse is true too: we have become too hygienic.

    The number of children with allergies has skyrocketed, because kids no longer play in the mud and in dirty streets.

    Germs are both our best friends and our worst enemies. We need to have a working relationship with these subjects.
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      Jul 7 2011: Yes, but I don't know if hospitals are the best place to train our immune systems...
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        Jul 8 2011: .
        Well that's because once you're in a hospital, you're generally not in a very healthy state...

        Building your immune system begins at birth, when a baby's tongue comes into contact with the mother's urine, faeces and filthy breasts.

        Did you know doctors and midwives in my country now have the habit of giving new born infants a brief "lick" of these "filthy" bacteria, seconds after they're born?

        Next comes playing outside, in the garden, in the mud, and in the dirt. Very important.

        Modernist architecture and urban planning have declared war on germs, long ago. The consequences have not all been that positive.

        It's all a matter of finding the right balance.
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          Jul 8 2011: I agree with the both of you! I made a comment earlier about not forgetting about "the hygiene hypothesis "
          My comment to Laurens was only pointing out that Hospitals (which the conversation is mostly about) isn't the right place to train your immune system, since death is likely...
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          Jul 9 2011: Birdia, That is a well known therapy for dealing with many psychological syndromes. Rolling the child or adult in a bundling fashion that 'hugs' the body and dampens the outside environment is helpful for many anxiety based disorders. Temple Grandin has done some TED talks. She is a high functioning Autistic and the first time I saw this was as a treatment she devised for herself. In fact, she also uses a similar concept when she designs slaughter houses for cattle to keep the animals calm.
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          Jul 9 2011: Temple's a TEDster!? I've seen the movie about her life and thought it was an amazing one and I'm happily surprised that she's a part of TED.
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          Jul 8 2011: A disturbing story indeed! I hope the parents of the kid got a second and third opinion!
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          Jul 9 2011: Birdia, I believe that some amazing and interesting things pop up during our conversations on TED and we should strike while the iron is hot. I think the exploration is the most vital and vibrant part of these discussions! "off topic' is not an issue that I believe has too much merit when we all have the freedom to skip entries. It's not as though we're wasting paper!
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      Jul 9 2011: Laurens, i think the issue of 'too clean' is up for debate and is confounded by too many factors to make certain of that assertion. Households that are compulsively clean also abound in cleaning products and excessive use of other things that could cause the damage to immune systems. We could also include the issues that Birdia is mentioning of psychological symptoms of both mother and child which involve anxiety disorders.

      If however, we stay on topic, it is clear that we should be able to stop a lot of deaths every year by simply getting people in hospitals- primarily staff to wash and sanitize their hands.
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        Jul 9 2011: .
        Debra, I wish to disagree. There is ample evidence for the assertion.
        1. Farm kids have fewer allergies than city kids.
        2. Kids with pets have fewer allergies than kids without pets.
        3. Kids who have been given bacteria from the mother's faeces right after birth have less allergies than kids who haven't.

        And a few days ago, there was this world news:
        "Scientists Discover That Antimicrobial Wipes and Soaps May Be Making You (and Society) Sick"

        In short, the evidence for the hypothesis that too much hygiene makes one weak, is growing steadily.

        We already know that the over-use of antibiotics makes super-bugs. That's why in my country there's now an anti-antibiotics law, which says doctors can only subscribe it when it's extremely necessary, and if they do not take care, they are contributing to making our society weak. Official policy!
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          Jul 11 2011: Thanks so much for those valuable contributions to the discussion. I will check ou the link. Even the title though refers to the type of soaps that I was speaking about. They contain triclosan, chlorhexidine and other anitmicrobials. Alcohol sanitizers will not be mentioned because they do not promote resistance.
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    Jul 6 2011: Reducing the number of patients per hospital by increasing the number of hospitals, increasing the number of personnels per hospital and reducing the stress at the same time.

    Increase the funds of scientific research. Research enough in genetics to understand the DNA language. Research for new possibilities and develop new treatments with synthetic biology and genetic engineering.
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      Jul 7 2011: Thank Maxime, all great suggestions. As populations age we will have more demand for hospital services and for medical professionals. Cost will become a serious problem. I think this infection issue is part of the reason why so many outpatient services are being engaged.
      When I had my first child the manditory hospital stay was 7 days with my last I was out in 12 hours.
      When I had my cancer surgery I was out in 4 days with a large hole in my body which was treated (and healed perfectly) by health care aides at my own home. Times are changing and will continue to do so.

      I really strongly suggest that no one enter a hosptial without an advocate who is brave enough and tough enough to insist that everyone who touches the patient in any way sanitizes their hands! We owe that sort of love and care to one another.
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    Jul 6 2011: If anyone can remind me of the talk where I think Venter spoke about creating a solution for c. difficile, I would appreciate it. I think I remember him speaking about losing a friend to the infection.