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Debugging Israel’s hospitals – a DIY guide

If the Israeli medical establishment isn't going to do all it can to prevent the spread of infectious diseases, you have to

Why would I even suggest that you take on this lofty, professional role yourself?

Well, anyone who’s lived here long enough knows that this is a Do-It-Yourself country. But even I — a nurse with an MPH staring down the 40th anniversary of my aliyah – was shocked to discover this morning that patients will now be even more responsible for preventing their own and their loved ones’ infections in most of Israel’s public hospitals.

The administrators of those hospitals announced recently that they are ceasing to report on their compliance with infectious disease prevention protocol to Prof. Yehuda Carmeli of the Israel Health Ministry’s National Infectious Disease Prevention Division. Calling these reports superfluous and valueless, they object to what they consider reporting to “one man” — Professor Carmeli — rather than a steering committee of experts.

“It’s crazy,” an anonymous senior hospital official told Rotem Elizera of Yediot Ahronot, “that I should I should have to receive instructions from them on how to act and what I have to report to prevent infectious disease. Because of them, instead of treating patients, I have to fill out questionnaires on subjects that are not important.”

I don’t want to scare you all, but I’ve been directly involved in monitoring infectious disease prevention and reporting in public hospitals in Israel. It’s my job as a nurse to be a patient’s advocate, and knowledge is power. So I’m letting you know.

A 2017 State Comptroller Report stated that between 300 to 500 deaths per year are attributable to infectious diseases acquired in Israeli hospitals.

The current breakdown in communications between Carmeli and the subsequent lack of reporting leaves the hospitals’ staffs to monitor their own behavior. The cat watching the cream, if you will. This leaves you — the patients — in hospital robes and flying by the nonexistent seats of your nonexistent pants.

But you and your loved ones can step up!

If you read Hebrew, you are certainly free to read the Health Ministry’s infectious disease prevention protocol yourself. and English-language readers may certainly rely on WHO recommendations to significantly reduce their risk of hospital-borne disease.

But protecting yourselves is far easier than studying lengthy protocol written for health professionals. “Health care-associated infections usually occur when germs are transferred by health-care providers’ hands touching the patient,” states the previously cited WHO document. There are or should be hand sanitizer dispensers at the entrance to every hospital unit and at the foot of every patient’s bed. The expiration date of the sanitizer (three months after the bottle is opened) should be clearly marked on the sanitizer. Few things have proven more effective in preventing spread of disease than using those up-to-date sanitizers on one’s way into a unit and one’s way out of a unit — בבואך ובצאתך, in your coming and your going. If you change units — let’s say you go to X-ray from another department — you do it again. That means everybody: patients, staff, and visitors must do the same.

Needless to say, no one should touch you-the-patient unless they have washed their hands first. But I have seen patients and their families who would not be afraid to grill the hospital staff about its kashrut observance — or cry “Gevalt!” and post “#MeToo” if someone touched their bodies without permission in any other setting — remain silent when a doctor pulls off a no-longer-sterile dressing to inspect a wound, without washing his or her hands first.

Every nurse I know sees a breach of hygiene on the part of doctors, nurses, paramedical staff, housekeeping, or orderlies weekly if not daily. And it is certainly our job as patient advocates to speak up loudest of all. But we too keep our mouths shut for fear of job security, advancement, or not going along to get along.

That leaves you.

I know. I know. You and your families are at your most vulnerable and you feel like the hospital staff holds your lives in its hands. But I don’t care how skilled those hands are in surgery and how sharp those minds are at detecting and treating disease and providing patient care. If those hands are dirty and those minds are too forgetful or distracted or sleep-deprived or burnt out or filled with ego to ensure that those hands get washed — those hands are not helping you.

That being said, I get that it is really, really difficult to speak up. But I hope that — just as in the #MeToo movement — if we all start speaking up and demanding better hygiene practices from hospital staffs, it will get easier for each one of us to say, “My body. My rules.” Or in this case, “Please wash your hands.”

I’ll let you in on two secrets: one of the things that the hospital administrators object to reporting are patients’ answers to recently introduced questionnaires that let patients and visitors anonymously rate cleanliness of rooms, staff hygiene, and patients’ satisfaction with their stay in the hospital; and the hospital administration reports submitted to the health ministry are not necessarily 100% accurate reflections of what happens “backstage.”

Thus, regardless of the outcome of what is now being called a “doctors’ rebellion” in reporting to the health ministry, we can and should demand that patient and visitor questionnaires remain a permanent feature of hospitalization in Israel.

We Israeli Jews must not let down our guard in demanding safe health care when the current flap is resolved, because as Jews, we are obligated by Jewish law — pikuach nefesh — to preserve life.

Jews in other nations should do the same to preserve life by promoting safe hygiene practice in their own hospitals. Those who loudly denounce terror, promote Israel’s security in social media, lobby their governments on our behalf, and donate to our institutions should also demand that our health care system improve the lot of our poorest public-hospital patients and contribute what they can to help us do so. After all, the yearly death toll from hospital-borne disease in Israel exceeds that from terrorism and war.

The Talmud says that one who saves a life is considered to have saved an entire world (Mishnah Sanhedrin 4:5; Yerushalmi Talmud 4:9, Babylonian Talmud Sanhedrin 37a). The Quran says that if anyone saves a life, it shall be as though he had saved the lives of all mankind (Surah 5 verse 32).

If doing so is as easy as washing your hands or telling a doctor to wash his or hers, would you do it? I hope you will.

About the Author
Varda Spiegel was Nurse-Director of the Bedouin Mobile Unit of the Negev, later serving as Maternal-Child Health Director for the Ministry of Health Jerusalem District. I am a grandmother, mother, and beachbum.
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