No quick fixes in medicine - whoda thunk it?

To many non-medical people, it really appears they believe the "fixes" to medicine are simple, deterministic (i.e., computerization as a panacea), and that many of the problems are generally a result of bad behavior by clinicians. The significant brouhaha about handwashing is such an issue:

Cleaner but not safer hands?
A study found that even when use of a gel rose at a hospital, infection rates were unchanged.

By Timberly Ross , Associated Press, Wed, Jan. 30, 2008

OMAHA, Neb. - Doctors and nurses on the go often skip soap and water in favor of an alcohol-based hand gel, thinking the quick-acting goo will kill bacteria on their hands and curb the spread of infection. Turns out that's not enough.

Workers nearly doubled their use of the alcohol-based gel at a hospital here. Their hands were cleaner - but the rate of patient infections was virtually unchanged.

The doctor who studied the problem pointed to many villains: rings and fingernails too long and hard to clean, poor handling of catheters, unsanitized treatment areas.

"There are many factors that influence the development of hospital-acquired infections," said Mark Rupp, an infectious-disease specialist at the University of Nebraska Medical Center who led the study at the adjoining Nebraska Medical Center. "It would be naive to think that a single, simple intervention would fix this problem."

His research appears in the January issue of Infection Control and Hospital Epidemiology.

The spread of infection-causing germs in hospitals is a huge problem, accounting for an estimated 1.7 million infections and nearly 100,000 deaths each year, according to the Centers for Disease Control and Prevention. These include drug-resistant staph,urinary-tract infections, and ventilator-associated pneumonia.

Mike Bell, who deals with infection control at the U.S. Ceners for Disease Control and Prevention, said that while he did not agree that hand gels did little to reduce infection, Rupp was right to say they were just one part of the solution.

"If they don't do everything else right, having clean hands is not enough," he said.

Unfortunately, "doing everything else right" calls for keeping a hospital, medical equipment, etc. scrupulously clean. That requires significant resources - meaning, chemicals, people, and labor. The current precarious financial condition of many hospitals would seem to preclude that. The financial problems arise from a number of actors including mismanagement, too much management, and declining reimbursement from payors.

It would seem current leadership of healthcare organizations by cost-cutting, profit-motivated management, as well as the for-profit desires for payers, cannot compete with several billion years of microbial evolution.

-- SS