Poor Hand Washing: Is It A Hard Habit To Break?

By Jeff Hall, Editor In Chief

No one would ever confuse me with being a neat freak. Anyone who has seen my office can attest to that. However, somewhere along the way, I became kind of fanatical about hand washing. As a result, I have really dry skin, but I am also rarely sick outside of the occasional headache. I don’t think that is a coincidence. I’m not sure where this fixation with hand washing started but it may have been an overzealous response to the bad habits I’ve observed among others who use public restrooms. Unfortunately, some folks use the facilities and walk right out without even venturing near the sink. Needless to say, this is disgusting. As a result, I now use a paper towel to open the restroom door to leave. Perhaps one of the worst experiences I’ve had in a public restroom occurred on a recent plane trip. I usually try to avoid using the bathroom on planes but there’s always the exception. Unfortunately, this exception just reaffirmed my policy. Bathrooms on planes allow almost no maneuverability. Unfortunately, as soon as I closed the door, I realized that the floor was wet. I didn’t even want to think about was on the floor but when I looked at the toilet seat, it was clear that someone’s aim had not been true. There were young children on the flight and some degree of turbulence, not exactly the best combination. When I went to wash my hands, it was a little difficult to do so as there was a huge amount of ice in the miniature sink. I figured one of the airline attendants (they’re always so helpful) dumped it there but why anyone would do so boggled my mind. I could barely get my hands under the faucet. To add insult to injury, the soap came out of the dispenser in a tiny trickle. My cautionary tales aside, the lack of hand washing is a serious issue in health care facilities. In an eye-opening article, “Notes Of A Surgeon On Washing Hands,” in the March 25 edition of The New England Journal Of Medicine, Atul Gawande, MD, MPH, noted that many studies have shown “that we wash our hands one-third to one-half as much as we are supposed to.” Benjamin Lipsky, MD, also commented on the role of hygiene habits in last month’s Podiatry Today supplement, “Treating MRSA Infections.” “Studies have shown that during the day almost everyone touches his or her nares, including most physicians,” noted Dr. Lipsky. “People who have S. aureus in their nose can get it on their hands and it goes from their hands to other people’s hands and then to their noses. Ultimately, it can colonize a break in the skin and cause an infection.” Given the increasing prevalence of nosocomial infections, particularly methicillin resistant Staph aureus (MRSA), reemphasizing the importance of proper hand hygiene is more essential than ever before. A recent Infection Control Today article discussed a 2000 study by Larson that examined the effects of an organizational culture emphasis on hand washing compliance at two hospitals. In that study, researchers found an over 30 percent decrease in MRSA rates and greater than 40 percent decreases in vancomycin-resistant enterococci (VRE) rates at the two hospitals. Despite these statistics, researchers have shown that people may return to their bad habits once the compliance efforts wane. Knowing that true compliance hinges on changing peoples’ behavior, institutions are focusing on longtime barriers to hand washing such as lack of access to hand washing facilities, lack of time in between patients and the effect soaps can have in drying out the skin. Increased sink automation, having antiseptic hand cleaners next to glove dispensers in every treatment room and the emergence of alcohol-based hand rubs are positive developments. Hopefully, they will help facilitate good hand hygiene as habitual behavior.

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