Coming clean about handwashing

Image: OJO Images | Getty Images

We’re all looking for ways to improve when it comes to hand washing. No fear. Where there’s a will, there’s a way. A little statistical analysis and self-reflection never hurt the cause, either. In this edition of MD/RN, Nurse Rebekah and Dr. Brady stop to look at the published evidence for hygienic practices in their department, the ED—and also come clean about their own hand-washing habits.

Nurse Rebekah: Dr. Semmelweis preached it, Florence Nightingale advocated for it and Purell has made a fortune off it: hand washing. It’s so simple, and yet we fail at it all the time. One study in the Annals of Emergency Medicine found that nurses in the emergency department only washed their hands 58.2 percent of the time when it was deemed necessary. Embarrassing? Yes. But at least nurses did better than the 18.6 percent of residents and 17.2 percent of attending physicians who met the mark. Subsequent studies could be cited, but this isn’t a term paper (I have enough of those to write). The general theme is that none of us is that great at hand washing, but at least nurses seem to be a heck of a lot better at it than others.

Dr. Brady: I plead guilty as charged. I’m a “germophobe” to some degree, so I’m probably a better hand washer than most of my colleagues, and still I’m certain I’m far from perfect. I would bet I’m above the 50 percent mark, though. The number one reason for failure, of course, is time constraints. In the ED it’s often rush, rush, rush. An alcohol-based rub certainly helps—when there’s one nearby and it’s not empty.

There really is no excuse for not washing your hands. This simple act protects both you and your patients. Hopefully in our failure, we’re at least prioritizing correctly and not skipping hand hygiene after touching patients with obviously contagious conditions.

By the way, it’s important to know that alcohol-based rubs have certain limitations. They don’t work for Clostridium difficile, a bacteria that causes a potentially life-threatening diarrheal illness, and they aren’t as good as soap and water for influenza (per a 2009 study by Grayson).

[main image: Chris Ryan | OJO Images | Getty Images]

What can hospitals and clinics do to make it easier for healthcare workers to wash their hands 100 percent of the time it’s deemed necessary? Does your unit have a clever solution?


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Brady Pregerson, MD

Brady Pregerson, MD, a returned Peace Corps volunteer and winner of the 1995 Wise Preventive Medicine Scholarship, completed his medical school at the University of California, San Diego, and his residency at Los Angeles County General Hospital. He has authored three medical pocket books for nurses and doctors, as well as the educational web sites and Pregerson currently works as an emergency physician in Southern California. He writes, "Although the ED environment may be quite different from working on the hospital floor or in an office setting, I am hopeful that you can take these tips and apply them to your own specific work situation." You can buy his books on lessons from the ER, including Don't Try This At Home: Lessons from the Emergency Department and Think Twice: More Lessons from the ER, at

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3 Responses to Coming clean about handwashing

  1. Aah, scary statistics. And gross ones at that. I do know that working in the ED, time is always the issue and when debating between saving the crashing patient vs washing your hands, I’m guessing most healthcare workers will choose the former. I think on the units the opportunity to wash hands is more feasible- you have less patients (we have three on our floor per nurse as opposed to seeing many in an ED busy time), you can put hand sanitizer outside each room or next to each bedspace as a reminder (which could also be done in an ED)… I know at Children’s we are following a “FOAM up” campaign that demands employees use the antiseptic foam outside each room before coming into contact with patients. And there are support techs that are responsible for making sure each of the bottles is full.

    We also have disguised auditors that monitor and count employees who do and do not practice hand hygiene prior to entering pt rooms and they print the statistics each month on the unit. I have heard/read mixed things about the effectiveness of hand foam (obviously the more convenient/less time-consuming option) vs hand washing and although I do agree with the Cdiff statement above, I have heard that in some other cases the hand foam is sometimes more effective. I always try to think of it in the patient’s eyes- if I were to ever be hospitalized, I would expect/demand that my nurses and doctors wash their hands before touching me, so I try to give my patients that same respect. But this issue is one of most consistently pressing issues at hand in the medical world. Best steps towards ideal solution? Education…

  2. Sean Dent

    A great tool was having a ‘reminder’ screen-saver at all computer workstations as well as having hand sanitizers everywhere need within the patient care floor.

  3. Elly

    Obviously a huge problem in healthcare … some infection control depts now have “spies” in the workplace that report on staff & MDs that don’t wash their hands. One big mistake that professionals sometimes make is that they don’t need to wash their hands if they glove. They do. Here’s the reminder … healthcare professionals can kill their patients by not washing their hands! How much more obvious can it be???