A Nurse Finds a Simple Answer to a Vexing Question and a New Career

Aug. 29, 2013Bookmark and Share

You probably think you know how to wash your hands, but Elaine Larson could tell you for sure.

An infectious disease expert who has published more than 200 papers on hand hygiene, Larson is the go-to source for commonly asked questions such as whether anti-bacterial soaps work better than regular soaps (no), whether alcohol hand sanitizer is more effective than hand-washing (yes) and whether you should really wash your hands for as long as it takes to sing “Happy Birthday” twice. (Not necessarily, just be sure to scrub between the fingers and under fingernails.)

Elaine Larson
Associate Dean for Research Elaine Larson speaking at the Association for Professionals in Infection Control and Epidemiology conference in Fort Lauderdale, Florida this past June.

The real risks, though, lie within hospital walls. “It doesn’t matter as much when you’re a healthy person in the lay public,” says Larson, the associate dean for research at Columbia School of Nursing, and professor of epidemiology at Mailman School of Public Health. “But in hospitals, the purpose of hand hygiene is different, particularly in an intensive care unit where patients are prone to infections.”

Larson was drawn to her research in the 1980s, when she was a staff nurse at the University of Washington Medical Center in Seattle. It started with a question: Why didn’t infection rates in patients in the ICU decrease after they were shifted from a large shared room to private rooms with individual sinks where hospital workers could wash their hands? Larson began looking at what kinds of bacteria were growing on the hands of health care professionals and found that the majority of those germs were the ones causing infections in patients.

“Over the years, a very simple question about hand hygiene, which people think is so basic and obvious, led to more questions and answers,” Larson says. Three decades later, her findings have shaped practices in hospitals and the general public. She was one of the first advocates for alcohol-based hand sanitizers and co-authored the Centers for Disease Control and Prevention’s 2002 guidelines for health care workers, which recommend the use of hand sanitizers instead of soap, in part because alcohol kills germs faster and doesn’t require sinks or towels.

For a surgeon doing a pre-operative hand scrub, using a hand sanitizer is equivalent to at least a five-minute scrub with soap. “When I started doing research on alcohols, the infection control community was against it because they worried that people would stop washing their hands,” Larson recalls. Now it’s a standard practice. This summer, Larson became the first recipient of the Distinguished Scientist Award by the Association for Professionals in Infection Control and Epidemiology for her contributions to hand-washing and other epidemiologic research.

Larson’s work has shifted beyond the germs that cause infection to the behaviors that promote hand-washing, specifically, how to get hospital workers to practice better hand hygiene. Infection prevention is crucial—the CDC estimates hospital-acquired infections cause nearly 100,000 patient deaths a year and cost the health care industry $30 billion. Larson’s research team is conducting studies in a Massachusetts hospital and in three pediatric longterm care facilities in New York using electronic monitoring. Employees receive feedback on how the group is doing. “We don’t record names because we believe that an infection-control practice has to be a team commitment,” Larson says. Preliminary results show the monitoring system improves compliance; the team will present some of the findings at IDWeek, an infectious disease conference in October.

Larson’s illustrious career was not planned; she is the first woman in her family to graduate from high school and became a nurse because nursing and teaching were the typical professions for women when she was young. She attended the University of Washington, where she received a bachelor’s degree in nursing, a master’s in nursing and microbiology, and a Ph.D. in epidemiology.

“I love nursing, and I can’t imagine a better career,” says Larson, who came to Columbia in 1998. “I got interested in science as soon as I started school and published my first peer-reviewed paper before I graduated.” Her curiosity has led her to other areas of academic expertise. She chairs one of the Columbia University Medical Center’s institutional review boards and runs a program to train researchers on methods to study infection control. “The fellows are nurses, physicians, computational biologists, microbiologists, epidemiologists,” she says. “What I love about infection prevention research is that by definition it is interdisciplinary.”

—by Beth Kwon

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