Doctor, Nurse: Have You Washed Your Hands?

It’s a well-known fact that hand-washing is one of the most important measures for reducing the spread of infection. Yet, healthcare workers, of all people, often fail to wash their hands!  One potential approach to this problem is to encourage patients, before submitting to treatment, to confirm verbally that doctors and nurses have indeed washed their hands.  But a new pilot study published in the Journal Infection Control and Hospital Epidemiology finds many patients are reluctant to question the hand hygiene of medical personnel.

According to an article on the study in Infection Control Today, patients in an Australian hospital were provided a brochure giving them permission to inquire if healthcare workers had washed their hands.  This small study found patients were willing to confront doctors only 43 percent of the time and nurses 67 percent of the time.  The report adds that “doctors consistently have the lowest [hand hygiene] compliance of all [healthcare workers].”  What’s going on?

Why Don’t Patients Speak Up?

Putting aside the problem of poor hand-washing rates among medical professionals, patients are often reticent to question those with whom they entrust their healthcare.  As a society we revere physicians and are usually confident they are acting in our best interests. One of the principal precepts of medical ethics, summarized in the phrase, “first, do no harm” renders inexcusable a doctor’s behavior that may lead to an infection in a patient; dare we call them on it?

Additionally, patients may fear offending their healthcare provider, thereby inadvertently reducing the level of care received.  Unfortunately, this may lead to a situation in which, instead of concentrating on the actual purpose of the visit, patients may be calculating the relative risks and benefits of speaking up on a matter unrelated to the reason for the appointment.

How Do We Fix Healthcare Hygiene?

One study of hospital intensive care unit healthcare workers found employing positive feedback raised hand-washing rates dramatically.  In situations where patients observe a lapse in hand hygiene, whether the hands belong to a doctor, nurse, or anyone else who is about to make skin contact, a tactful reminder is in order.  The patient may do this by inquiring as to the hand hygiene policy of the organization.  Alternatively, patients might point out in a friendly way that the CDC website encourages patients to remind doctors and nurses to wash their hands (CDC podcast).

Patients deserve the peace of mind that their medical visit will not result in a preventable infection. Let’s hold all those employed in healthcare to a reasonable standard of hygiene.  Patients, speak up!

Barbara M. Soule, R.N. MPA, CIC, is an Infection Preventionist and a member of the Water Quality & Health Council.