On the blog

Monday, 7 February 2011

Sanitation: A Doctor’s Perspective - Guest Post by Dr Richard McCrory

A graduate fresh out of medical school anxiously sits at a trainee induction day listening to reminders of a vital skill that will effectively save lives and reduce illness throughout their entire clinical career.

That skill is…

…wait for it…

…Hand washing.

Yep, Hand washing.


Why would infection control practitioners spend hours reinforcing hand washing techniques to a band of such apparently ‘enlightened’ and ‘knowledgeable’ people?

Healthcare professionals in a modern age of technological advancement can lose an appreciation for the simple activities in our clinical practice that can produce such significant impact.

A single person infected by a bug such as the Rotavirus can have millions upon millions of its particles in each gram of poo, but it only takes between 100 and 1000 of these particles to cause disease in a neighbouring person. An unwashed hand, contaminated food, water or clothing is all it takes to spread it along.

Consider this, the bacteria which causes cholera requires several hundred million organisms to infect a healthy individual. However it an illness that generates such copious volumes of diarrhoea (up to 20 litres per day), this means that adequate distribution within a community is incredibly simple once a dysfunctional or non-existent sewage system has been overrun.

In 2007, a poll of readers of the British Medical Journal chose ‘The Sanitary Revolution’ as the most significant medical milestone in the past 140 years. Pioneering individuals in the 19th Century such as John Snow , Edwin Chadwick and Thomas Southwood Smith sought the prevention of human contact with waste as a means of minimising associated health problems. Although modern understanding of infection has advanced since this time, the practices developed during this time are as applicable now as they were then.

Yet inadequate sanitation remains a problem in the developing world.

In countries and territories where the majority of the population don't have access to the healthcare facilities we take for granted, it is vital that simple technologies such as latrines are easily accessible. This helps to reduce the transmission of opportunistic micro-organisms throughout the community.

Children being taught the importance
of handwashing in Burundi

As a charity Toilet Twinning helps facilitate the construction and maintenance of these structures in Sub-Saharan Africa.

This strategy, in conjunction with access to clean drinking water, as well as educating communities in taking collective hygiene action, have the potential to cut mortality rates connected to diarrhoeal illness. Such cuts could be as dramatic as those seen following the Industrial Revolution. It could also be a major factor in facilitating the release of communities from the bondage of poverty.

Yet for all the knowledge entrusted to medical students, they often need reminding at the start of their professional career that simple habits can benefit their patients the most.

It is essential that the general public gains a refreshed appreciation of the gift of clean running water and functional sanitation which a quarter of the world’s population still needs access to.

So my final thought is to doctor and lay-person alike:

Remember! Wash your hands… and twin your toilet!

Dr Richard McCrory MB MRCP is a graduate of Queens University Belfast. He also completed a BSc in Microbiology during his studies. Dr McCrory is currently a Core Medical Trainee in the National Health Service, instructs Advanced Life Support and is keen to pursue a career in nephrology. His interests include Geocaching, music and film. You can find him on Twitter (@iamdoctord).
(Photo credits: www.scotland.gov.uk and Toilet Twinning, Nick Wilmot)

1 comment:

  1. so far as my knowledge would go that washing hands is the most basic way to avoid physical contact disease. There are many proven studies about this and that maybe why that doctors promote proper hand washing.