Comment Re:India ? (Score 1) 273
You're thinking of the washing that you do in the bathroom. I looked up Gawande's words and found that I understated the time to wash. Here's how he describes it.
First, you must remove your watch, rings, and other jewelry (which are notorious for trapping bacteria). Next, you wet your hands in warm tap water. Dispense the soap and lather all surfaces, including the lower one-third of the arms, for the full duration recommended by the manufacturer (usually fifteen to thirty seconds). Rinse off for thirty full seconds. Dry completely with a clean, disposable towel. Then use the towel to turn the tap of. Repeat after any new contact with a patient.
Almost no one adheres to this procedure. It seems impossible. On morning rounds, our residents check in on twenty patients in an hour. The nurses in our intensive care units typically have a similar number of contacts with patients requiring hand washing in between. Even if you get the whole cleansing process down to a minute per patient, that’s still a third of staff time spent just washing hands.
And it's not always possible to hire more staff, especially when strict adherence to washing means you have to hire half-again as many staff to do rounds. While there are some private hospitals making a healthy profit, not all of them do, and there are a lot of hospitals that are run by governments, churches, or non-profits and their margins are thin to non-existent. The need to purchase new equipment just to keep up with other hospitals can obliterate that margin in a single purchase. Doctors tend to send their patients to whichever hospital has the shiniest toys and patients want it that way. Failure to keep up with the newest technology puts revenue at risk and may mean cutbacks that further damage the hospital's ability to effectively treat its patients.