Do No Harm

As to diseases, make a habit of two things — to help, or at least, to do no harm.

Editor-in-Chief, Chester ‘Trip’ Buckenmaier III, MD, COL, MC, USA.

I do not believe there is a health professional on the planet that has not heard this quote from Hippocrates. It is as close to a postulate of medicine as anything I have come across. The value of Hippocrates’ teaching set forth in this quote resonates louder this month since the focus of this issue of U.S. Medicine is infectious diseases.

Bacteria and viruses certainly predate the dawn of mankind and have played a major role in our evolution and social development. Infectious disease has felled kings, destroyed empires, rendered armies impotent, and now can be used as a weapon of mass destruction, possibly with more devastating power to kill our civilization than even nuclear weapons.

With the development of antibiotic chemotherapy as a science by the German medical scientist Paul Ehrlich in the late 1880s, modern medical science has managed to keep the scourge of infectious disease at bay during the 20th century and today. Unfortunately, bacteria and viruses have tremendous capability to adapt and evolve when challenged. Our overuse of antibiotics has rendered many infectious disease organisms resistant to these medications.

One particularly disturbing fact about the overuse of antibiotics is up to 70% of all antibiotics sold in the United States are given to farm animals. The antibiotics are used to promote growth in unnaturally crowded conditions, but this practice promotes drug-resistant bacteria that can spread to humans.1 With the medical “trump card” of antibiotics at risk of becoming useless, prevention of disease must again return to the spotlight of modern medicine.

Beginning in 1843, Dr Oliver Wendell Holmes staunchly advocated that physicians wash their hands to prevent the spread of infection among their pregnant women patients. Many physicians of the time failed to understand the connection between infectious disease and poor hand hygiene and therefore viewed hand washing recommendations with skepticism or outright disdain.

Our understanding of infectious diseases and their spread is far more sophisticated today and the importance of hand washing to prevent infection is advertised throughout our federal medicine institutions. The United States Centers for Disease Control and Prevention have stated: “Hand washing is the single most important means of preventing the spread of infection.”

Modern medicine enjoys a clear understanding of the infectious disease problem and the ubiquitous availability of waterless, alcohol-based hand antiseptics that have made the simple task of hand washing even simpler. Despite these advantages, compliance with hand washing guidelines before and after any patient contact remains below 50% in most institutions, according to Dr Donald Goldmann in his New England Journal of Medicine article, System Failure versus Personal Accountability—A Case for Clean Hands.2 In this same editorial, Goldmann notes how other industries, such as computer-chip manufacturing, are able to enforce cleanliness standards that include a special suit, gloves, and mask to prevent damage to expensive chips and thus financial damage to the company from the loss of millions. Workers in this industry face significant penalties and/or dismissal if they fail to comply with cleanliness standards. Our patients are certainly no less valuable and yet we continue to have difficulty in enforcing simple hand washing protocols within our own community.

“First, do no harm.” This entreaty from medicine’s past should be enough to encourage all federal healthcare providers to be fastidious about their hand washing for their patient’s sake. Federal medicine leaders must ensure the institutions under their charge are providing the appropriate hand hygiene education, facilities, and supplies for health providers to clean their hands before and after every patient encounter. Finally, employee accountability standards for hand washing must be at least as stringent as industry standards with similar cleanliness needs.

Like the microchip industry, millions of healthcare dollars are at stake when we fail to achieve proper hand hygiene and spread nosocomial infections. Unlike the microchip industry, poor hygiene in the medical profession is not just a question of money. It literally is the difference between life and death for tens of thousands annually. It is worth repeating, “At least, do no harm.”

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