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?


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 Dr. 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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