Simple precautions could save lives, doctor says

Yutaka Tsutsumi isn’t pushing for an eye-catching medical discovery like a cure for cancer. He simply wants doctors to become aware of the need for safety measures, like washing their hands.Still, the assistant professor at Tokai University in Isehara, Kanagawa Prefecture, believes his mission could save a number of lives. That’s because widespread, and sometimes lethal, infections often start when simple preventative measures are ignored, he says.”Most doctors don’t practice basic things to ensure medical safety,” he says.Until recently, Tsutsumi, 45, was alone in his campaign to convince both medical care providers and health administrators that doctors and other medical workers urgently need basic safety education. “Hospitals are infected with viruses and bacteria,” he says. “But medical staffers, as well as patients, are likely to fall into risky complacency believing they are safe as long as they stay in hospitals. Nurses are relatively well educated about the problem, but the situation is terrible among doctors.”Doctors often even fail to wash their hands between patients — a practice Tsutsumi calls the main culprit of hospital infections. When he recently asked a medical trainee if he washes his hands after seeing each patient, the trainee replied, “Nobody told me to wash my hands,” he said.The young doctor had just finished his two-year clinical training in various departments at Tokai University Hospital, Tsutsumi says. “An enormous amount of medical knowledge is poured onto students, whereas such a basic thing can be so easily forgotten,” he says.Most medical institutions in other industrialized countries have infection nurses specializing in infection control within the hospital, but most Japanese hospitals have none. Safety education for doctors in Japan lags behind programs in other industrialized countries in which hospitals implement sets of basic measures called “universal precautions,” Tsutsumi says. The term “universal precautions” remains relatively unknown in Japan, he adds. “When I asked about 70 new graduates of Tokai University Medical School in April if they knew of the term, most of them said no.”Hospital infections gained public attention in the 1980s when an antibiotic-resistant bacteria called methicillin-resistant staphylococcus aureus (MRSA) caused several deaths in hospitals across the country. Japan’s first survey concerning hospital infections, conducted in 1988 by Kumamoto University researchers, found that 29 of every 1,000 inpatients had been infected.The number of hospital infections, which are believed to result largely from the excessive use of antibiotics, has decreased in recent years with the gradually increasing awareness among doctors of the cause of the problem, a Health and Welfare Ministry official said. However, the ministry does not know how many lives have been lost by such infections because there is no system requiring hospitals and clinics to submit such statistics, the official said.In December, vancomysin-resistant enterococci (VRE) was detected in Tokyo, marking the nation’s first such case. VRE is a new type of antibiotic-resistant bacterium that is considered more dangerous than MRSA.Some hospital officials say they disinfect floors and walls to prevent such infections. But Tsutsumi says these measures are off the mark.Floors, doors, beds and toilet seats are not likely to be the medium by which the viruses and bacteria are transmitted as long as they are properly cleaned, he says. “There are two main culprits of infections at hospitals: invasive instruments, such as hypodermic needles and medical tubes, and the hands of medical workers,” Tsutsumi says. “If they are contaminated with bacteria, they will transmit the bacteria to patients. “What makes the problem worse is that many medical staffers, whose primary task is to save lives, are not aware that they could transmit dangerous germs,” he says.