Doctor, Wash Your Hands!

Abstract & Commentary

Synopsis: In 2834 observed patient care situations in which handwashing was indicated, the latter took place in only 48%. Noncompliance with handwashing was more frequent in intensive care units and among physicians as compared to other healthcare workers.

Source: Pittet D, et al. Ann Intern Med 1999;130:126-130.

In this observational study in a large teaching hospital, trained infection-control nurses recorded potential opportunities for and actual performance of handwashing during 20-minute observation periods spaced randomly during all shifts over a period of 14 days. Observations were made in a sample of 48 wards, including intensive care units, that comprised 70% of the hospital’s 1382 beds. Opportunities for handwashing were defined as all situations in which it was indicated according to published guidelines. Personnel were not aware of which aspects of handwashing were being studied, and no feedback was given during the data collection.

In 2834 opportunities for handwashing, average compliance among all healthcare workers was 48%. Compli-ance with handwashing in the 450 opportunities in intensive care units was 36% (odds ratio for noncompliance compared to internal medicine units, 2.0, with 95% CI 1.3-3.1). As a group, physicians washed their hands least often of the types of healthcare workers studied: with the odds ratio for noncompliance among nurses taken as 1.0, that for physicians was 2.8 (95% CI, 1.9-4.1) by multivariate analysis, while that for nursing assistants was 1.3 (95% CI, 1.0-1.6). The odds ratio for noncompliance among other healthcare workers was intermediate between those of physicians and nurses.

COMMENT BY DAVID J. PIERSON, MD, FACP

In this study from Geneva, Switzerland, handwashing was considered to be indicated before and after patient contact; whenever there had been contact with body fluids, broken skin, or other potential sources of microorganisms; and after removing gloves. These criteria are consistent with those in most American hospitals, and the fact that handwashing occurred on average less than half the time when it was indicated is discouraging. Other studies have documented the low overall rate of handwashing in hospitals, particularly in intensive care units. In addition, this is not the first study to show that physicians perform less well in this respect than do nurses and other healthcare workers. In this time of increasing emergence of bacterial pathogens resistant to multiple antimicrobials, we need to emphasize the importance of handwashing, probably the most important single factor in the nosocomial transmis-sion of such organisms. Doctor (and nurse, respiratory therapist, anyone involved in patient care)—wash your hands! (Dr. Pierson is Professor of Medicine, University of Washington, Medical Director, Respiratory Care, Harborview Medical Center, Seattle.)

In the study of Pittet et al, how often did handwashing occur overall, when it was indicated in patient care situations?

    a. 88% of the time
    b. 70% of the time
    c. 57% of the time
    d. 48% of the time
    e. 31% of the time