Do doctors wash their hands as often as they should? Multiple studies say they don’t so this blog takes a look at the history of handwashing in hospitals, as well as some dirty facts about doctors and handwashing.
Modern-day healthcare professionals (HCPs) know that germs spread disease and that good hand hygiene is critical. But does that mean HCPs necessarily wash up as often as they should?
Before we tackle that question, let’s take a quick look at how hand washing came to be a healthcare practice in the first place, because up until a the mid-1800’s, it certainly wasn’t.
A brief history of hospital hand washing practices:
It was Ignaz Semmelweis, a Hungarian doctor working at the Vienna General Hospital in the 1840s who we have to thank for making the connection between poor hand hygiene and infection.
The hospital was one of the largest in the world and its maternity wing was so big that it was divided into two wards: one for doctors and one for midwives. The two wards had starkly different maternal mortality rates, with the mortality rate in the midwives ward almost a third of that in the doctors’ ward!
Semmelweis started to investigate, but it was only when a colleague cut his finger on a scalpel during an autopsy and developed an infection that killed him, that Semmelweis started to consider whether similar types of infection could be happening in the doctors’ maternity ward.
Semmelweis realized that doctors sometimes examined women in the maternity ward after performing autopsies (which the midwives did not do) and he hypothesised that women in the doctors’ ward might also be dying because cadaveric matter from doctors’ hands was entering their body through their genitalia.
Although this was technically incorrect, Semmelweis’ response to his theory was to mandate that doctors wash their hands with chlorinated lime after autopsies. This resulted in a big improvement in maternal mortality, and between 1848 and 1859 the maternal mortality rate in the doctors’ ward dropped to around the same level as the midwives’ ward.
Around about the same time as Semmelweis was working in Vienna, the American doctor Oliver Wendell Holmes published a paper arguing doctors with dirty hands could cause childbed fever in their patients. The British nurse Florence Nightingale, considered the founder of modern nursing, wrote in her 1860 publication Notes on Nursing that “Every nurse ought to be careful to wash her hands very frequently during the day.” British surgeon Joseph Lister drastically improved patient mortality by advocating that surgeons wash their hands and sterilize their instruments in between patients.
Regardless of these few pioneers, the importance of hand washing for medical professionals didn’t really become understood until the late 1800’s, when scientist Robert Koch determined guidelines to prove that a disease is caused by a specific microorganism, invisible to the naked eye, and the concept of germ theory was born.
Which brings us up to date…
Today, HCPs consider hand washing a critical hygienic practice, both for themselves and their patients. To properly kill germs, good practice dictates scrubbing them with soap for at least 20 seconds before rinsing the soap off with water. Drying them completely is also important, since wet hands spread germs more easily. You can read more about that in our blog post: 4 reasons why drying your hands is so important.
So back to the burning question…
Do doctors wash their hands as often as they should?
According to the Institute for Healthcare Policy and Innovation, hospital acquired infections (HAI’s) affect almost two million people in the United States every year, 100,000 of whom die. Up to 70 percent of these infections could be prevented if health care workers follow recommended hand hygiene protocols. By my estimation, that’s a lot of unnecessary – easily preventable – illnesses, infections, and death, when hand hygiene is universally acknowledged to play a major role in preventing HAI’s.
And if it feels like the statistics alone are not enough to answer the question, there are numerous studies that seem to point to the same answer. For example:
In Greek healthcare facilities:
The results of a study carried out at 10 large hospitals in Greece recently showed that only one in three doctors and nurses in Greek hospitals apply hand hygiene rules before having contact with patients, according to a new report. And fewer than half the nation’s healthcare staff wash their hands before carrying out any aseptic patient-handling procedure.
Experts believe that poor hand hygiene compliance in Greece’s hospitals might be the reason why the number of micro viruses developed by patients treated with venous catheters – the most common hospital-acquired infections – is six times higher in Greece than in, say, the US.
Before the pandemic, one in 10 patients in Greece picked up a hospital-acquired infection while an estimated 3,000 patients died from an HCIA every year. This compares with an average of six per cent in general across the rest of the EU.
In European healthcare facilities:
In a European multi centre study, in which a hand hygiene improvement program was implemented in 13 ICUs in eight countries, hand hygiene adherence was, on average, 52% in the 6-month baseline period, and improved by 12% per month after implementation, reaching a plateau level of 77%.
Despite the compelling logic underlying hand disinfection in the hospital setting, adherence to hand hygiene standards by health care workers generally has been abysmal, and surveys performed specifically in the NICU have recorded compliance rates as low as 22% to 28%.
In German operating theatres:
The results of a hand hygiene observational study in operating theatres of an orthopaedic university clinic in northern Germany during July and August 2020 were equally underwhelming, with hygienic hand disinfection compliance by surgeons was approximately 41%.
A study in 2010 examining research on hand hygiene in hospitals around the world reported that just 40 percent of health care workers comply with recommended hand hygiene guidelines which, at a minimum, emphasize proper hand hygiene before and after touching the patient.
Why is it still so hard to get healthcare workers to wash their hands?
Study after study show that doctors and other healthcare providers wash their hands less than half the time. The nurses did better, but still only 48-percent of the time. Some factors that reportedly hindered hand-washing were workload and a feeling of not being watched.
An alternative to frequent hand-washing is the liberal use of hand-rub disinfectants. The Annals of Internal Medicine study on the attitudes of doctors towards handwashing showed that if hand-rub disinfecting solutions were at the patient’s bedsides they were more likely to use them.
A World Health Organization (WHO) report listed other barriers to adherence with hand-washing guidelines. These included:
- Working in the ICU, surgical unit, or emergency rooms
- being a nursing assistant (rather than a nurse), or physical therapist
- Sinks are inconveniently located/shortage of sinks
- Lack of soap and paper towels
- Handwashing agents cause irritation and dryness
- Understaffing and overcrowding
- Wearing gloves and the belief that using gloves avoids the need for hand hygiene
- Not thinking about it/forgetfulness
- No role model from colleagues or superiors
- Scepticism regarding the value of hand hygiene
- Disagreement with the recommendations
Not just healthcare workers
But it’s not just HCPs who fail to wash their hands — patients and the general public also fall short. Prior to the Coronavirus pandemic studies consistently showed that adherence to hand washing guidelines by the general public was poor. We rounded up some common excuses to why people don’t wash their hands in an older blog post.
Having said that, the last 2 years have seen people become increasingly savvy about hygiene. Initial’s Global Hygiene Reset Report is of the largest global hygiene surveys to focus on the impact that COVID-19 has had on hygiene attitudes and behaviours – reaching 20,000 respondents in 20 countries around the world – including South Africa.
Our research revealed that in South Africa clean hands are more important to people than ever:
- 83% of people surveyed wash their hands more frequently when in public indoor spaces as a result of the COVID-19 pandemic,
- 84% of people said they wash their hands more frequently now to protect themselves from common viruses such as the common cold, influenza and norovirus than they did before the COVID-19 pandemic,
- 82% of people surveyed said they are likely to wash their hands more frequently in future to protect themselves from common viruses.
If handwashing is important to you – and we really hope it is – talk to Initial about improving hand hygiene in your business to ensure your employees and customers are protected against the risk of cross contamination and illnesses caused by poor hygiene practices.