'Doctors don't wash hands'

Doctors only wash their hands 40% of the time they are supposed to, global studies have shown.

This is despite it being an essential component of infection control that helps to prevent the spread of bacteria between patients, says University of KwaZulu-Natal pharmacologist Andy Gray.

Groote Schuur Hospital's Professor Marc Mendelson says "hand hygiene is appallingly done, globally". He suggests teaching patients to ask doctors if they have washed their hands.

With drug-resistant infections on the rise, infection control is one way to prevent patients getting an untreatable infection when they are in hospital for a different ailment.

"We're already in the post-antibiotic era in South Africa," said Mendelson.

Every large academic hospital in South Africa has had people die from infections resistant to antibiotics, he said.

More than 23 000 people die every year in the US from drug-resistant infections. There is resistance to last-resort antibiotics called Carbapenams in South Africa.

Once a patient is resistant to these, antibiotics from the 1960s, which are much more toxic, with worse side effects, should be used, says Professor Koleka Mlisana, head of microbiology at the University of KwaZulu-Natal.

"If the old drugs don't work, all you have is prayer," she added.

A few antibiotics are expected to be produced by pharmaceutical companies over the next 15 years for certain bacteria, says Mlisana.

But people also "create" their own drug-resistant bacteria by taking antibiotics for flu even though they do not work for viral infections.

Mendelson says this harms the patient and the people to whom they transfer resistant bacteria.

"About 50% of all antibiotic use worldwide is inappropriate," he says, adding: "In a study in 2012, researchers found that patients in public and private ICUs were on 10 antibiotics at one time."

Mendelson and colleagues set up an antibiotic stewardship team that monitored patients' use of antibiotics in two of the wards. They used this time to teach doctors about the drugs and change prescriptions where necessary.

The programme decreased the use of antibiotics in the two wards by almost 20% over two years.

Patients did not die or get re-admitted due to less use of antibiotics.

"There is global evidence that proper stewardship programmes reduce antibiotic resistance," said Mendelson.

To improve infection control Discovery Health has pioneered an initiaive called Best Care to prevent hospital patients getting infections from lines that are inserted into their bodies to carry drugs or blood to them.

They insist doctors wash hands and put on masks and sterile clothing before inserting a line.

Discovery estimates this has prevented 1200 infections in private hospitals a year, saving an estimated 150 lives annually .

An infection from a central line doubles a patient’s hospital costs and increases a patients chance of death by up to 25% said CEO of Discovery Health Dr Jonathhan Broomberg.