Asking Your Doctor to Wash His Hands

There was an interesting discussion thread on Medscape this week in response to a blog entry about ways to motivate physicians and other providers to wash their hands before touching patients, especially in the hospital setting. You can read the article (“Should physicians be 'punished' for not washing their hands?” by Leslie Kane) and readers comments at http://boards.medscape.com/forums?128@659.wafwa9HxmrR@.29f8f873!comment=1

(You may need to register…it’s worth the few minutes it takes to sign up. Medscape membership is free and provides access to a searchable database and weekly news updates in a variety of medical specialties.)

Hand washing has been known to prevent infection for the past 150 years and despite education, incentives and rewards, fines and penalties, doctors still only wash their hands one-third to one-half as often as they should.

Not surprising then that the Centers for Disease Control & Prevention estimates that patients develop 1.7 million nosocomial or hospital-acquired infections each year resulting in 99,000 deaths.

What was surprising was the number of defensive comments from doctors in response to Ms. Kane’s article. Beyond the usual excuses: takes too much time; forgetfulness; wearing gloves, etc., there were others blaming patients, their family members and friends, and cleaning contractors. This comment from a cardiologist stood out:

“Too much drama. Do I want my doctor at the bedside or at the sink? Resistant staph comes from another useless and valueless practice, misuse of antibiotics. Too much hand washing and we will have soap resistant staph. 
By the way, staph lives in the nose. Do we need to rinse out our nose also on the way to the bedside. 
Frequent hand washing is a sign of OCD. Give it up. Wash the stethoscope after every use? Oh My!! ....”

Okay so maybe he or she has a point about the misuse of antibiotics as a contributing factor but it is not the only one. And there are some hospitals that are testing the effectiveness of swabbing patients’ nostrils and throats on admission to minimize the spread of infections that patients bring with them...maybe doctors are next. But overall, the dismissive tone of this and  comments from other providers is troubling.

So, what do you do as a healthcare consumer?

Speak up.

If a doctor or other healthcare provider is touching you or a family member without washing his or her hands and/or without gloves, remind them that hand washing is the right thing to do. And if you have any hesitation, ask yourself, “Would I rather feel a little uncomfortable now or spend weeks in the hospital fighting a potential deadly infection like methicillin-resistant Staphylococcus aureus (MRSA).”

Dr. David Shulkin of Beth Israel Medical Center and author of “Questions Patients Need to Ask” suggests that you don’t let a healthcare provider touch you before:

• You’ve seen him wash his hands, either in a sink or with an alcohol-based gel sanitizer. You can say something like, "I’m sorry, but I’m really afraid of infections. Would you mind washing your hands before we start?"
• You’ve seen him wash before he puts on gloves. The gloves won’t protect you if they’re contaminated from unwashed hands.
• He has wiped and sanitized instruments that will touch you, including blood pressure cuffs and stethoscopes. Hospital staff use alcohol pads or cleaning cloths with disinfectants, such as ammonia, to clean equipment.

Know the infection rates at your hospital.

You can find information about infection rates as well as how well a hospital takes care of patients with certain conditions and their success rates for various surgical procedures at http://www.hospitalcompare.hhs.gov

Learn more.

Watch a brief video at http://abcnews.go.com/2020/superfreakonomics-dirty-hands-deadly-infections/story?id=8861823

Spread information...not germs.

Here are a few messages that British researchers found worked best for promoting personal hygiene in public restrooms:

• "Washing hands with soap avoids 47% of disease."
• "Soap it off or eat it later."
• "Don't be a dirty soap dodger."
• "Don't take the loo with you, wash with soap."

Reference

Judah G, Aunger R, Schmidt W, et al. Experimental Pretesting of Hand-Washing Interventions in a Natural Setting. American Journal of Public Health. v99(S2);S405-411. Accessed 1/23/10 at http://ajph.aphapublications.org/cgi/content/abstract/99/S2/S405