Iatrogenesis, derived from a Greek word meaning “brought forth by the healer”, is used to describe any negatives effects caused by the physician during healthcare.
First do no harm” (primum non nocere), a part of the Hippocratic oath is the first lesson taught in medical school. Iatrogenic illness or death caused purposefully or by negligence is a punishable offence in many countries.
Causes of iatrogenic illness are many. Negligence, anxiety, improper dosing, unnecessary and illegal prescriptions, nosocomial infections, faulty procedures, to name a few.
A major iatrogenic catastrophe in the 19th century of puerperal sepsis outbreak in maternity wards, due to transfer of pathogens from autopsy rooms, was first identified by Hungarian physician, Ignaz Semmelweis.
The significance of handwashing was thence brought to light.
“Handwashing is like a ‘do-it-yourself’ vaccine”, quotes the Centre for disease control and prevention(CDC).
Its quick, its simple, its one of the best things you can do if you care for your patients and yourself.
We all know this.
But do we follow it?
One obvious reason could be the lack of time and facility at the moment of need.
Handwashing and disinfection can kill most kinds of microbes including Tuberculous and Anthrax bacilli, HIV and Influenza virus, and most fungi.
For proper disinfection, hands should be washed with soap and water for a minimum of 15 seconds and air dried, followed by thorough application of alcohol containing sanitizers. Sanitizers with minimum concentration of 70% or ‘persistent’ antiseptic activity is recommended to all healthcare professionals.
Commercially sold sanitizers may contain lesser concentrations.
One of the questions arising on the safety and efficacy of sanitizers is resistance by microbes.
The answer to it is ‘persistence’.
Persistence or residual activity, means prolonged or extended antimicrobial action by the antiseptic agent.This property is seen highest in Benzalkonium chloride, a much superior antiseptic than alcohol.Due to this property, there are no reports till date of resistance against alcohol containing santizers, but emergence of MRSA against Benzalkonium chloride has been found.
Another concern is regarding the removal of normal skin flora along with the pathogens.Since it is replenished quickly from other body parts due to its high proliferative nature, there is no harm to the skin.
Handwashing with only water does not readily remove the ‘oily’ contaminants.
The common everyday soap, being reusable, hold bacteria from multiple exposure.Liquid soap, on the other hand, is a safer option if the disposing pump is at check.
An easy on-the-go alternative hand sanitizer may disinfect your hands, but the contaminant would be still present.
Antibacterial wipes are ubiquitously practical, but are notorious in spreading further infections in case of improper disposal and usage of one tissue on multiple surfaces.
Alcohol free sanitizers, being widely promoted these days, may be quite effective but are more prone for contamination during storage and adverse reactions.
Alcohol being an in-solution preservative protects it unless grossly contaminated.
Sterile gloves are the safest choice, if accidental breakage and disposal are monitored.
Little is given regard to the post-washing ritual of drying.
A study conducted by the European tissue symposium says that electronic drying devices increase bacterial load by 200%, being a suitable niche for its growth and cross contamination;while fresh paper towels decrease it by 77%.
Frequent use of products may strip off skin’s natural oil barrier, leading to dryness and infection prone skin.
A fix to this is using products with emollients and good moisturisers.
Care should be taken while using alcohol containing santizers due its highly flammable nature.
Newer methods of hand hygiene are antiseptic hand sprays and foams, automated-dose regulated pumps, hospital reminder alarms to nurses and doctors, activated and electrolysed water.
Personal hygiene cannot be fully practised at all times, but the more we know, the greater potential for overall safety.