March 2008 Volume 32 No.3

Paging Dr. Semmelweis — and
‘Get in the Playground’

Sometimes a few of us may feel a bit like Hungarian physician Ignaz Semmelweis — but not at the seminal moment when he made his bold, spot-on call at Vienna General Hospital in 1847 that washing hands in a maternity ward would save lives. No, I’m thinking ahead a few years to 1865 when colleagues humiliated Semmelweis, believing that his weird new theory was evidence that he had lost his mind. (Of course calling colleagues who didn’t wash their hands "murderers" was probably not the most tactful way to disseminate germ theory). Nevertheless, Semmelweis was committed to an insane asylum, as they were called then, where he died 14 days later. (One theory, not apropos of the point I’m coming to, is that he was beaten to death by guards.)

Yet, nearly 150 years later, the hand washing issue is very much present, and some of us may be feeling a tinge of Semmelweis’ oft-described frustration. One of our patient safety goals is to reduce hospital-acquired infections. Articles continue to proliferate about how bacteria spreads from patient to patient through contact by health care providers. Inadequate hand hygiene among health-care workers has been blamed for contributing to approximately 2 million health care-associated infections in hospitalized patients a year. Sound familiar?

We launched a campaign many months ago appealing to all personnel to wash their hands between patient contacts. To facilitate this, SHC has placed alcohol gel stations just about everywhere you turn. They are in the halls outside of patient rooms, inside every patient room, in the clinics, and we now even have stations at many of the entries to the hospital and patient units. (Semmelweis would have been impressed with these convenient gels. His disinfectant of choice was chlorinated lime solution).

By now I would have hoped that all of us would have been able to adopt hand hygiene into our normal routine by just automatically going for the gel dispenser every time we go in or out of a patient room. But, in spite of this and many other efforts to get all of us to “gel in and gel out,” we have had very disappointing results when we send in “secret shoppers” to survey hand washing. We physicians as a group stand at about 33 percent compliance with hand washing between patient contacts.

Some of you are saying we need to be a little more creative in finding ways to increase the number of gellers. Should we encourage our patients to ask their physicians if they have washed their hands prior to examining them? Another suggestion is that we have people hand out yellow cards to anyone observed not using proper hygiene; this would be akin to handing soccer players a yellow card when they commit a foul.

Personally, I believe that the solution centers around making sure we remind each other to do the right thing. In fact, when people are reminded, they use the gel and say, "Oh I forgot."

So we will be encouraging everyone — patients, family members and colleagues — to remind others to use the gel if they observe otherwise. If we do that, we won’t need yellow cards or the preemptive shame of asking patients to monitor this for us.

By the way, use of the gel is not limited to touching patients with un-gloved hands. It is important to remember to gel before and after using exam gloves as well. In fact even if you are going into a room and do not plan to touch the patient, you should still use the gel — it will help us make this practice routine and make sure we are ready if we do need to touch a patient.

You will see many signs posted about the hospital with a large hand with many germs depicted on it. The inscription on the signs read "Committed to preventing the spread of infections through proper hand hygiene. Every time. No exceptions. No excuses." Let’s just do it: let’s bring hand hygiene compliance to 100 percent, even if it has taken nearly 150 years after Semmelweis’ tragic demise.

On another note, I am sure by now all of you know that the roll out for CIS-Epic has been rescheduled to April 25. Our staff had been trained on this new software by Feb. 29, our original “go live” date. So it’s a bit awkward to have nearly two months between training and actual use of our new skills. But many of us, including me, learn best by "playing" with a new computer program until comfortable. Fortunately, we can “get in the playground,” a computerized environment where we can use the CIS-Epic program with fictitious patient names to navigate lifelike exercises replicating what we will be doing. Put simply the more familiar we are with CIS-Epic the better off our patients and ourselves will be at go-live.

You can "get in the playground" now from virtually any computer with internet access. To do so outside the Stanford Enterprise Network you will need a token device or key-FOB, which can be obtained by contacting the Help Desk at (650) 723-3333. You will also need to use your new system user identification, (SID), which should have arrived in the mail. Your SID begins with the initial s and is followed by seven digits and a password for the Enterprise Network. (See related story.)

You have likely been sent instructions on the SID and “Playground,” but in any case, you can access information about these related topics here on the Medical Staff website.

So please grab these instructions and join me (virtually, anyway) on the Epic "Playground," so we all will be comfortable with the new software prior to go-live.

For questions regarding Epic please contact the Help Desk at (650) 723-3333. For questions during the transition you may also contact stanford.learning@accenture.com or call, 24/7, (800) 394-7970.