Not gelling

Atul Gawande has an article in this week's NEJM about hand washing. He was disturbed to learn that the adoption of those alcohol-gel dispensers outside patient rooms has not reduced nosocomial infections, despite the fact that it bumped hygeine compliance up from 40% to 70%.

I'm surprised, too -- I love those gels, and really thought they might stem the tide of MRSA and VRE sweeping the hospitals (now more than 10% of hospital patients have one or both). Gawande compares the success Lister had in promoting OR sterility, to the heckling and nagging employed by Semmelweis to staff to wash their hands -- and notes that, 130 years later, operating rooms remain vigilantly sterile, but floor beds could still use someone to nag the staff.

Gawande suggests something akin to an OR circulating nurse for the ICU or floor, but dismisses the idea as too expensive and running counter to the culture. I suspect that the problem will have to get even worse before people are ready to invest in comprehensive changes. But you could say this about other problems in health care, too.