Doctors and Nurses: Wash Your Hands (Even if No One Is Looking)

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Hello and welcome. I am Dr George Lundberg, and this is a Medscape Evidence-Based Patient Safety Minute.

Before Pasteur and Lister and knowledge of germs, Ignaz Philipp Semmelweis challenged medical dogma in Vienna in 1847.[1] As the equivalent of chief resident at age 29, he discovered that washing hands with chlorinated lime solutions after autopsies and before delivering babies could drastically reduce the incidence of frequently fatal puerperal fever, from around 10% to about 1%. Shunned by the medical establishment, Semmelweis raged against lack of cleanliness. Ultimately, he was committed to an asylum and died of septicemia after being beaten by guards.

Fast-forward to now. Some physicians and nurses still have trouble washing their hands.

In July 2016, six Canadian authors published a study[2] in the Journal of Hospital Medicine that reported observations of trained teams of medical students, who surreptitiously spied on their teaching physicians and on nurses, scrutinizing hand hygiene across multiple different clinical services during weekly rotations. This covert hand-hygiene behavior by physicians was compared with hand-hygiene compliance as measured by the hospital auditors during the same period. Physician hand-hygiene compliance was 84% when overtly observed and 50% when covertly observed. For nurses, compliance reached 86% when overtly observed vs 45% when covertly observed. When attending physicians cleaned their hands, 79% of physician trainees also did; when attendings did not, only 19% of trainees did.

The Hawthorne effect is alive and well in Toronto, Canada. Physician leadership in hand washing remains critically important.

I am Dr George Lundberg, At Large with a Medscape Evidence-Based Patient Safety Minute.


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