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by Abigail Van Buren

DEAR ABBY: May I add a few thoughts regarding the letter from "Daughter of a Patient," who wrote to stress her concerns about health-care workers and hand-washing? I strongly confirm that health-care workers need to demonstrate frequent and proper hand-washing techniques. Gloves are required while performing invasive procedures such as starting an IV, drawing blood, changing a dressing, etc. But please do not assume that hand-washing did not occur if it was not done in the patient's visual field.

I have been an RN for more than 20 years. I wash my hands before and after patient contact -- always, without fail. Our institution does not allow us to use a patient's bathroom for our routine hygiene (unless our hands become soiled while in contact with that patient). Nurses, physicians and other health-care personnel in direct contact with patients generally use a central hand-washing area, such as in a nurse's station. In this case, patients and their families may never actually observe personnel washing their hands -- even though they have.

However, if a patient or family member actually sees a health-care worker going from one area to the next, one patient to the next and having direct skin contact with that patient, I suggest they report it immediately to the unit manager. A health-care worker is more likely to acquire an infectious disease from the public than the other way around. That's now twice the reason to observe good hand-washing techniques. -- INFORMED AND HYGIENIC RN IN CALIFORNIA

DEAR INFORMED RN: The majority of mail I have received from medical personnel corroborates your statements. Read on:

DEAR ABBY: In response to the letter about hand-washing by medical personnel -- yes, it probably could be better in some cases. I have been an RN for 12 years.

Just because a patient doesn't see me wash my hands, it doesn't mean I haven't done it just before I entered the room. I generally wash my hands at the nurses' station for several reasons. I don't believe a patient's room or bathroom is the most hygienic place for me to wash my hands before I assess the patient.

At my hospital, the soap kept in the nurses' station is a stronger germ killer than what is kept in the patient rooms. Furthermore, I often follow hand-washing with an antibacterial spray or lotion of my own. With the dramatic rise in antibiotic-resistant bacteria these days, such precautions not only protect patients, but also protect me. -- SUSAN KELLY, SCOTTSDALE, ARIZ.

DEAR ABBY: Twenty-five years ago, a group of veterinarians developed and patented a hand-washing device that would give a surgical scrub in 30 seconds. A portable model that could be placed on a cart and moved from room to room was available. Prototype models were proved effective by bacteriologic testing. Though several companies expressed interest, we were never able to bring the device to market.

While there have been tremendous advances in the medical field in the last 25 years, the age-old problem of contaminated hands, first described by Semmelweis in the 19th century, still persists. -- WILLIAM V. LUMB, DVM, PHD, FORT COLLINS, COLO.

DEAR DR. LUMB: Unfortunately, you're right. And hand-washing is still the single most effective method of disease prevention. To quote an old saying, "The more things change, the more they remain the same."

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