How Public Policy Impacts the Way Hospitals Make Decisions

By Sasha Viasasha



Hospital administrators regularly address questions larger than efficiency and productivity when it comes to helping people live healthier lives. At the same time, public policies can shift sharply with little notice as new information and technology become widely available. Leaders in healthcare are expected to react faster than those in other industries simply because it matters so much to so many. Following best practices while keeping in step with the latest societal consensus is the primary challenge of being a responsible healthcare provider.


Perhaps one of the best examples to illustrate this is the way handwashing has become an increasingly significant public policy issue in the U.S. In the 19th century, handwashing was considered an outlandish recommendation; today, it is the foundational element of healthcare in the country.


Handwashing in Medicine First Proposed


For centuries, handwashing—first with water, then with soap—was simply a cultural or religious act, considered essential to personal or spiritual hygiene. That way of thinking changed dramatically in the 19th century when the global worldview turned suddenly to embrace scientific hypothesis-testing and to adopt new technologies.


In the U.S., polymath Oliver Wendell Holmes introduced the concept of handwashing as critical to stopping the spread of disease in “The Contagiousness of Puerperal Fever,” presented to the Boston Society for Medical Improvement in 1843. Holmes’ investigation was prompted by the death of a doctor just a week after he had conducted a postmortem exam on a patient with puerperal fever. His findings were largely ignored because Holmes was known primarily as a poet and the scientific study was published in a tiny journal that soon went out of business.


Mortality Rates in Obstetric Clinics Linked to Hand-Transmitted Infections


Many others were following this same line of reasoning at the time though, and leading the charge was Ignaz Semmelweis in Vienna, Austria. Semmelweis was a doctor at two obstetric clinics in 1846 when he noted that one clinic had a much higher maternal mortality rate than the other: 10 percent vs. 4 percent. While investigating the disconnect, a friend of his died from an infected finger after a postmortem exam on a woman with puerperal fever, just as in the case that Holmes had investigated.


Semmelweis observed that midwives were trained by doctors (like his friend) who performed autopsies at the first clinic. At the second clinic, midwives had no contact with doctors performing autopsies, which indicated to him that the infection from puerperal fever was being transmitted by the hands of the doctors. Semmelweis immediately instituted a policy that anyone attending autopsies had to scrub their hands in chloride of lime before coming close to the maternity wards at either clinic. As we would now suspect, maternal mortality rates plummeted and Semmelweis was hailed a hero.


Medical Establishment Fails to Accept Findings


What we might not suspect was that Semmelweis was demonized by other physicians of the day. They insisted that infections originated not from contaminated hands but from “miasmas” in the aether or unbalanced humors in the blood of patients that could be cured with bloodletting and leeches.


In the U.S., Holmes and others who saw the import of this work took note of how Austrian and European society in general failed to act on the findings of Semmelweis. To effect real change, investigators and practitioners adopted a policy of “recognize-explain-act.” Without the presentation of a strong motivational explanation to enlist the support of regulatory and governmental organizations, significant findings tend to be forgotten or suppressed. The lessons of Semmelweis were forgotten until Florence Nightingale championed handwashing in Italy during the Crimean War. Despite individual efforts like these, handwashing would not been seen as an essential hygiene practice in U.S. hospitals for many years to come.


CDC Publishes First Hand Hygiene Guidelines


It would take many decades and national public policy change campaigns across the U.S. before this basic truth was accepted by the general public. Despite well-founded research and clear evidence of handwashing as an effective barrier to many common communicative diseases, it wasn’t until the 1980s before the Center for Disease Control published its first national hand hygiene guidelines.


Those guidelines evolved and grew more sophisticated in the years to follow. In the mid-1990s, bolstered by the birth of the World Wide Web, the CDC, and the Healthcare Infection Control Practices Advisory Committee were able to reach a much wider audience and gain considerable public policy support for the use of antimicrobial soap or a waterless antiseptic agent as the preferred mechanisms for medical personnel to clean their hands after working with patients who presented indications of multidrug-resistant pathogens.


Global Handwashing Day Instituted


Just 16 years ago, those public policy guidelines shifted again in response to new technology for delivering alcohol-based hand rubbing as the preferred practice for hand hygiene in healthcare, even over and above handwashing.


By 2008, 84 percent of U.S. hospitals had adopted alcohol-based handrubs as their primary method of infection control. The present guidelines are based on this previous document and represent the most extensive review of the evidence related to hand hygiene in the literature.


Finally, the steady increase in adoption of handwashing as an important medical practice led a consortium of governmental bodies and commercial interests to introduce Global Handwashing Day on October 15, 2008. This is just one of a host of initiatives dedicated to better hand hygiene with the goal of stopping the spread of infectious disease.


In 2018, the healthcare industry is in flux again as astonishing new possibilities come into play, such as wearables for monitoring health data in real time, analytics for determining the efficacy of healthcare worker compliance, and cloud-based apps distributed over mobile devices to keep everyone on track.


Something as simple and intuitive as washing hands has proven to be a powerful tool in the fight against disease, but only after it was enforced by governmental bodies and adopted by hospitals. Public policy reminders, enablement technology and the ongoing dedication of healthcare workers has not been enough, but now technology is coming to the aid of healthcare professionals.


Vitalacy has sought to change the public's ingrained behaviors and slow the growth of resistant-bacteria by crafting a solution on three fronts: the Internet of Things (IoT), wearable technology, and machine learning.


With this powerful combination of tools, Vitalacy is able to have rich data and optics into workflow compliance and provide this information to hospitals, empowering them to reach their goals and minimize HACs.



Sasha Viasasha writes on the science of healthcare. Her current works are centered around patient-centered IoT development, machine learning, and analyzing data from wearable medical devices.



Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866610/

https://www.pbs.org/newshour/health/ignaz-semmelweis-doctor-prescribed-hand-washing

https://globalhandwashing.org/about-handwashing/history-of-handwashing/

https://www.ncbi.nlm.nih.gov/books/NBK144018/

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666622/

https://globalhandwashing.org/global-handwashing-day/

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