Hand washing: Public humiliation works

Sep 9, 2009 3:53 PM

As flu season approaches, everyone is talking about hand washing, especially health-care professionals. But will more talking mean more doing? A couple of public humiliations helped make me become a better hand washer.

The first occurred when, as a relatively new certified nurse midwife, I was training to assist on cesarean sections. I scrubbed in with the doctor, chatting as we completed the ritualized five minutes of hand washing. We were off to a good start--or so I thought. But when we were gloved and gowned and ready to go the doctor said, "So, who trained you to scrub anyway? Start over, and this time keep your hands up, so the dirty water doesn't run back over them." As the assembled operating room team watched and waited, I shamefacedly washed my hands again. Suffice it to say my presurgical hand washing became scrupulous that day.

The second occurred in my office at the hands of a well-informed patient. I had just finished what I considered to be an exceptional prenatal visit and was saying as much to the office staff when they informed me that the patient had refused to see me again. The offense? I hadn't washed my hands before her physical exam.

I really hate washing my hands at work. Twenty-five patients a day means about 50 opportunities to sing the "Happy Birthday" song for 20 seconds, or scrub fanatically with foaming alcohol solution, or wait for the finicky motion-activated dispensers to send out a paper towel. It means time taken away from other tasks. I just don’t want to do it. Nor am I alone. According to one analysis, health-care workers don’t wash their hands about 60 percent of the time. High-risk settings like intensive-care units or frequent exposure to contaminated material actually pushes this number up, as does being a doctor (instead of a nurse), being male, or working in a busy environment where frequent hand washing is required.

Though I know the value of a well-timed complaint, as a patient I seldom return the favor. I have remained inexplicably silent through egregious hand-washing lapses as I sat in dental chairs, during Pap smears, and even when seeking care for a contagious illness. How many times have you noticed that your health-care provider failed to wash up before and after a physical exam, or after removing gloves? Has anyone ever reached to readjust an unprotected light and then reached back to touch you again? This year, as flu season approaches, we should all start noticing and speaking up. After all, as I well know, a little public shame can go a long way.

—Joan Combellick, certified nurse-midwife

Read our suggestions from nurses, doctors, and others on hospital hand washing, watch our hand washing video, and follow our swine flu coverage and recommendations.