Transcriber: Eunice Tan Reviewer: Tanya Cushman
I'd like to ask everyone to take a moment and look at your hands.
So go ahead - take a look at them.
What do you see?
What do you think about when you look at your hands?
Do you think to yourself,
"Wow, my hands are amazing!
(Laughter)
They help to get me through my day in ways I can't even count."
Or do you think about holding the hand of someone you love?
I think about those things,
but when I look at hands,
I also see 15 million germs.
And I think,
"What surfaces have these hands touched?
And what was on those surfaces?"
And I think how hands -
mine, yours, anyone's -
how under some circumstances,
can be silent killers with a simple touch.
Every day when I go to work as an infectious disease microbiologist,
I handle bacteria that could kill you.
As such, people often wonder if I'm a germophobe.
It's a good question.
At work, yes, I have to be.
I have a responsibility to make sure the resistant organisms I work with
don't escape the lab.
But in my everyday, regular life, do I constantly worry about germs?
Well, it depends.
When at home, if food falls on the floor,
I firmly believe in the three-second rule,
(Laughter)
especially when dessert is involved.
(Laughter)
Where I am a stickler, though, is when it comes to hand hygiene
because the simple act of cleaning hands
is our first line of defense
to preventing infections for ourselves and others.
Now, this notion that germs from our hands cause infection
is generally understood today,
but that wasn't always the case.
Once upon a time,
illnesses were largely thought to be caused by "evil spirits"
and foul-smelling air called "miasma."
It wasn't until the mid-1800s
that medicine becomes more scientific,
and we have a Hungarian physician named Ignaz Semmelweis,
who was so disturbed by the mortality rates
of women dying in the medical student ward,
as compared to the midwife ward,
of childbirth fever
that he set out to understand why they were dying at such alarming rates.
After many failed attempts,
he finally made a connection:
that the root cause of the fevers and untimely deaths
was because of "cadaver particles."
Now, he didn't know that these cadaver particles,
as he called them,
were actually bacteria.
However, by implementing a rigorous hand- and instrument-cleaning process,
he was able to reduce the mortality rates
from 18% to below 2% in just two months.
After an amazing discovery like this,
one would think that Semmelweis was revered as a savior of women,
receiving praise and accolades from his colleagues.
Mmm - not so much.
Although Semmelweis correctly identified the problem,
he went about mobilizing change in all the wrong ways.
Instead of gently bringing his colleagues around to his understanding,
he chastised them.
He called them "irresponsible murderers!"
Thus they turned against him.
And with enough time,
he vexed them so thoroughly
they had him committed to an insane asylum,
where he was severely beaten
and died 14 days later
from childbirth fever.
Although not appreciated at the time,
Semmelweis's discovery is just as important and powerful today.
We all know when we're supposed to clean our hands, right?
We learn about this as toddlers.
You're supposed to clean your hands before touching food,
after cleaning up after a pet or a child,
after touching dirty surfaces in public, like doorknobs and elevator buttons,
and, of course, after we go to the bathroom.
This is not earth-shattering news.
What might be earth-shattering
is that we're in the midst of an infection crisis all over again,
where 1 in 25 patients that go into the hospital
come out with an infection they didn't have to start with.
In 2011,
the CDC reported 750,000 hospital-acquired infections
in U.S. acute care hospitals alone.
And of those infected patients, 75,000 of them died.
That's more deaths than prostate, breast, colon cancer
or diabetes.
Each year, these infections cost between 28 and 45 billion dollars,
but there is no figure
that can be placed on the burden incurred by patients and their families.
And unfortunately, I have met too many families
who, like mine, have been affected by these kinds of infections.
Years ago, when my research focus
moved away from antibiotic discovery to infection prevention,
I wanted to be part of making sure
future patients would not become a statistic.
This was particularly at the forefront for me
during my dad's recent open-heart surgery and recovery.
So again, it might be a surprise
to learn that what Semmelweis correctly identified -
this hand hygiene issue -
170 years ago
is still at the core of the infection crisis we have today.
How can this be?
Well, it turns out cleaning hands is not as simple as you might think.
But instead of me just telling you about it,
now comes the audience participation part.
So as you were coming in, you were all handed hand sanitizer.
So together,
we are going to learn how to clean our hands like healthcare workers,
according to the World Health Organization.
Now, what's important for you to understand
is that when you're talking about the level of clean,
or "efficacy" as we call it,
it's going to be dependent on a very specific volume
deposited in a very specific manner
over a very specific amount of time.
And, really, what I need you to remember
is you need enough product on your hand to cover the surface of both hands
because sanitizer can't kill what it doesn't touch.
So we're going to put a good dollop -
(Laughs)
I'm not going to say a full palmful, because then it'll take forever -
but a really good amount to cover the surfaces.
And now what we're going to do -
try not to splash yourself in the eyes -
is we're going to go palm to palm,
and we're going to go with one palm to the back of the hand -
very good -
and switch - good.
And now we're going to go back palm to palm,
fingers interlaced, apart.
Good - you're not done yet.
Now you've got to do the backs of your fingers
and the tops of your nail bed -
switch hands.
Really important - don't forget your thumb.
This is the most commonly missed part of hand hygiene.
And don't forget your fingertips.
Okay.
And now we wait because they're so wet.
This is important:
your hands are not considered clean or safe until they are dry.
The active ingredients are still working on killing the organisms.
So now that we've all done that,
how was that?
By a show of now-clean hands,
how many of you have done this kind of cleaning before?
Oh, that's good! All right, keep your hands up.
How many of you do this level of cleaning
every single time?
Yeah, that's what I thought.
Who has time for that, right?
So,
data suggests that we can't even get people to clean their hands
when you know you're supposed to.
So, for example, one out of five people
opt to not wash their hands after using the bathroom.
Wait, wait - I want you to think about this for a moment.
So look down your row
and maybe the row in front of you or behind you -
(Laughter)
20 people did not wash their hands after using the bathroom today.
How many hands have you been shaking so far?
(Laughter)
Aren't you glad we just cleaned our hands?
I know I am!
So when you think about it,
as individuals, it's kind of okay for us to make poor hand hygiene choices,
especially when we're healthy.
The reality is that our robust immune system
is going to take care of any of the germs that we inadvertently leave behind.
However, what are the ramifications
when a healthcare worker in a hospital, nursing home,
dialysis center, or emergency room
can't clean their hands the right way every single time?
Every interaction between a patient and a healthcare provider
is an opportunity to prevent an infection
or transmit one,
which makes sense
because practitioners are around germs, infections, and sick people all day.
So let's talk time for a moment.
If a practitioner were to clean their hands using soap and water
every time they task-switch,
as recommended by the World Health Organization,
they would be cleaning their hands for half of their shift.
That would be half of their day not focused on direct patient care.
When using popular hand rubs like we just did,
that's still one-quarter of their day dedicated to cleaning hands.
The practitioners I've spoken to
barely have time to go to the bathroom during the day,
never mind dedicate this much time to cleaning hands,
so they're forced to cut corners.
They only can clean hands going in and out of patient rooms,
and that leaves numerous opportunities for germs to be spread.
170 years ago,
Semmelweis tried to save lives by getting people to wash their hands.
Today's hospital administrators
are essentially asking the exact same thing.
But in today's system, things are different.
What is asked of the healthcare worker
is not feasible
and likely wouldn't solve the problem anyway.
For a moment, let's wave our magic wand,
pretend that we live in a world
where everything in a healthcare setting is feasible.
Given the hand hygiene products we have access to today,
it still might not be enough to prevent the spread of infection.
How can this be?
Let's take a look.
If an invisible sneeze droplet contains 200 million germs
and our sanitizer kills 99.99% of them -
take a moment to do that mental math:
move the decimal four places -
(Laughter)
ew,
that's 20,000 germs that are left behind.
That is more than enough
to spread an infection to one of our stick figure friends,
especially if that friend is in the hospital.
And to complicate things,
hand sanitizers can't even kill all the important pathogens or germs
that are found in hospitals today,
like highly contagious norovirus
or debilitating Clostridium difficile, also called C. diff,
which can survive on surfaces for up to eight months.
So what we have on our hands are likely a lot of germs
and a problem that cannot be solved solely with an individual behavior change.
We need innovation.
And it seems really tempting to think,
surely, we have a solution to the problem.
We just need to get people to do it, right?
We have easy access to soap and clean water.
We have sanitizer on every wall and doorjamb.
On-the-go sanitizers come in every color, shape, size, fragrance -
disinfecting wipes, towelettes, sprays, foams, gels.
Yet the spread of infection still persists.
How can that be?
Well, it turns out that despite the fact
that sanitizers come in a variety of forms,
they all use the same active ingredients
that were formulated more than 40 years ago.
If cell phone technology stalled in the 1980s,
this is what would be in your fanny pack right now.
That's right, I said "fanny pack" because this doesn't fit in your pocket.
So I ask you -
how can we ask healthcare workers
to use the equivalent of an '80s-style technology
and then hold them accountable
for not fulfilling 21st century expectations
in their work?
How did we get here?
So,
I largely believe that innovation has stalled in the hand hygiene space
because of antibiotics.
So during World War II,
the development of penicillin
saved countless soldiers' lives from dying in the trenches.
In fact, penicillin is so good at treating infections,
that in the 1950s and '60s,
it ushered in the golden age of antibiotic discovery.
And without a doubt,
antibiotics continue to play the role of unsung hero,
saving millions of lives today.
However, the development and commercialization of antibiotics
had negative side effects that exacerbate the problem in hospitals today.
With a cure for bacterial infections in hand,
we stopped innovating ways to prevent the infections from beginning.
And because we had no idea of the downstream consequences,
our misuse and abuse of antibiotics
has led to the formation of resistant organisms like superbugs,
which are increasingly more difficult to treat.
And the presence of those resistant superbugs
means that prevention is more critical than ever
given our inadequate current methods.
So are there things that you can do?
Yes.
Among them - don't misuse antibiotics.
Only take antibiotics for confirmed bacterial infections -
they don't work against viruses.
Take them exactly as prescribed,
and always, always, always finish your course,
even when you're feeling better.
And when out and about,
let's make smarter choices
about when and how thoroughly to clean our hands,
like during cold and flu season or when handling raw chicken.
And wash your hands after using the bathroom
every single time.
It's just gross not to.
And when visiting the hospital,
be mindful that every surface you come in contact with
could harbor dangerous germs,
and those germs could be passed along to unsuspecting victims.
And when visiting your loved ones,
remember they are more vulnerable to infections.
So clean your hands often, and try not to touch them.
I know that's hard.
After my dad's surgery,
everyone who came to visit wanted to share their concern
and extend a tender touch and sympathy.
But I was vigilant in making sure
every single person who entered his room
cleaned their hands and limited unnecessary contact.
I know I offended some,
but I am grateful my dad did not become a statistic.
So are there things that we can do as individuals?
Yes.
But we also need to look beyond individuals;
we need to look at the problem holistically.
We need for companies, researchers, hospital administrators
to prioritize innovating in the infection-prevention space.
170 years have passed
since we discovered clean hands save lives.
Our friend Semmelweis
was unfairly condemned to an insane asylum
for mobilizing change in all the wrong ways.
However, continuing to do the same things we have been doing
and expecting a different outcome -
it's its own form of insanity.
So I challenge you to join me -
thinking outside of the box -
in developing better ways to prevent the spread of infections in hospitals
that will work in today's hospital setting.
Together we must have the courage to reject the status quo
and usher in a transformative hand hygiene revolution.
Thank you for listening.
(Applause)