Washing Our Hands of the Swine Flu

As of May 1st, 2009 11:00 AM EST there are 141 confirmed cases of the H1N1 “Swine Flu” in the United States, spanning 19 states and including 1 death. The World Health Organization (WHO) has raised the worldwide pandemic alert level to Phase 5 (of a possible 6) signalling that a pandemic is “imminent.” The U.S. Government has declared a public health emergency. As we speak the Centers for Disease Control and Prevention (CDC) is mobilizing antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help contain the outbreak. In the face of this looming threat what is our recourse? In our modern age of minimally invasive surgery, 256-slice CT scanners, and targeted chemotherapy what is our best defense against the swine flu? What’s our first and best hope for containing this pandemic? It is… wait for it… hand washing. Hand washing? Surely you’re joking.

Apparently not. President Obama in his press briefing on his 100th day in office said: “…I’ve asked every American to take the same steps you would take to prevent any other flu: keep your hands washed, cover your mouth when you cough, stay home from work if you’re sick, and keep your children home from school if they’re sick.” For their part, the CDC  agrees – the official pandemic flu website (www.pandemicflu.gov) recommends that we all take “everyday preventive actions,” by which they mean to avoid close contact; stay home when you are sick; cover your mouth and nose; clean your hands; avoid touching your eyes, nose or mouth; and practice other good health habits (e.g. proper sleep, hydration, and nutrition). Here at the University of Chicago Medical Center we are being given the same message: stay home if you’re sick, wear a respirator mask, wash your hands.

It appears that hand washing is no joke. In 2004 the WHO launched a multi-year initiative to reduce the spread of hospital-acquired infections, infections caused by deadly and often highly-resistant bugs that patients get in the hospital. After months of research, rigorous debate, and input from infectious disease experts around the world, the WHO decided that the focus point of their initiative would be on improving hand hygiene. In the Summer 2007, I had the opportunity to go to Geneva to work on the Clean Care is Safer Care initiative and was astounded by the results. Data collected in hospital after hospital showed that simply improving hand hygiene reduced hospital-acquired infections by as much as 50 percent.

Annecdotally, I can offer my own story of the benefits of hand washing. As a child I was frequently sick. Going to the doctor 10 to 12 times a year for flu-like illnesses, earaches, and stomach bugs was not uncommon. As I got older the visits to the doctor became less frequent but the illnesses didn’t – that is, until this year. For some reason this year, my first year of being a full-time doctor I have yet — knock on wood — to get sick once. I accomplished this feat despite being in constant contact with patients, despite working through the winters holidays and flu season, despite being exhausted and nutritionally deprived all of the time (yes, internship is a true joy). How did I stay healthy and flu-free despite the odds? After much deliberation the only thing I can point to is hand washing. This year I have washed my hands more times than any other year in my life. I wash or disinfect my hands 30 to 50 times a day. I clean my hands before seeing each patient and after seeing each patient and sometimes even once or twice while seeing a patient. And inevitably, after a long day of a work, I first thing I do when I come home is to generously lather my hands and face with soap to rid myself of the day’s abuse.

But simply knowing the benefits of hand washing isn’t enough. In his 2004 article “On Hand Washing,” Atul Gawande illustrates the many challenges we healthcare workers face in observing proper hand hygiene (accessible at www.nejm.org). It is time-consuming, easy to forget, irritating on our hands, and lacks tangible benefits. The result is that even within hospital settings where there is easy access to disinfectants we only wash our hands one-third to one-half of the time. Outside the healthcare system it is easy to imagine that regular hand washing is only more difficult. Still, by making a habit out of washing our hands after each contact, carrying alcohol-based hand sanitizers in our pockets and handbags, and putting hand hygiene in our conscience we can keep our hands cleaner and ourselves healthier.

The swine flu is scary. But the solution doesn’t have to be. If you’re sick or under the weather, stay home. Stay rested and well hydrated. And above all, wash your hands. After all, in a literal sense, the outcome of this epidemic is in your hands.

- Shantanu Nundy, M.D.