I spent several hours at the out-patient clinic of our local hospital last week, most of it in a waiting room near the main entrance. I had a great view of the hand sanitizer dispensing stations, and watched the people washing – or not – as they came and went through the doors.
Not Enough People Washing
The first thing I have to say is not enough people were washing! Most patients and visitors seemed to be washing as they came in, but frequently they neglected to wash when they left the building. This is an important step that helps to prevent communicable diseases such as influenza and Healthcare-Associated Infections (HAIs, also sometimes called nosocomial infections) from getting out of a healthcare setting like a hospital or nursing home, into the community.
HAIs include illnesses such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and C. difficile, that tend to be present mostly in healthcare settings and are caused by bacteria or viruses you can come into contact with, even if you are just visiting the hospital for an hour or two.
Proper handwashing as you enter and leave the building, as well as any time it indicated by staff or by posted instructions (e.g. entering or leaving a patient’s room) helps to keep you and your family safe, and also protects patients in the hospital from being exposed to opportunistic infections and keeps infectious diseases from getting out into the wider community.
Doctors Not Washing
As I watched the comings and goings at the door, one thing that struck me was that people wearing obvious hospital gear – scrubs, uniforms and those wearing hospital ID badges, were not stopping to wash their hands. I watched that sanitizer station while dozens came through, and not a single one stopped to wash.
This doesn’t come as a surprise, because I’ve seen it before. I worked in a hospital for seven years before I was married, and I rarely ever saw a doctor wash his hands. Nurses were better about washing, especially if they felt they had soiled their hands (e.g. changing a dressing) but I have witnessed plenty of nurses too, neglect to wash when entering or leaving a patient’s room – even when that patient was in an isolation room.
These observations are borne out by more recent experiences as a patient and when visiting family in hospital, but more importantly by research in many regions of the world. This is no an isolated phenomenon, although trends show hospital staff are getting better facilities (e.g. hand sanitizer dispensers) that support handwashing as required, and compliance is growing as the improvements are made and our understanding of disease transmission increases.
Poor Handwashing Technique
Of the people I saw using the hand sanitizer, few seemed really to know how to wash. Most of the people I saw washing were women, and most of them seemed to use the sanitizer as though it were hand cream – a quick rub on the outsides of the hands, and that’s that.
Hand sanitizers, and even soap and water, only do their job if we scrub all the surfaces of our hands and wrists. A cursory rub is not going to do the job, even if it does make your hands smell pretty!
Wash All the Surfaces of Your Hands
To do a thorough job of washing your hands with either sanitizer or soap and water, be sure to rub all the surfaces: front and back of the hands, between fingers, under the nails, thumbs and wrists. Use about two pumps of sanitizer and rub until your hands are dry. Don’t shake the excess off or use a paper towel. It’s meant to take 20 or 30 seconds. This short investment of time pays off big dividends, as you help to keep yourself, your family and your community safer. So don’t cheat!
Won’t All This Washing Hurt My Hands?
It can if you use harsh, anti-bacterial soaps or if your skin gets dried out. One of the best defenses against illness is intact skin. Use a sanitizer with an emollient in it, so your skin feels soft and smooth after use. Most brands have this. If you are washing with soap and water, use mild liquid hand soap. Pat your hands dry, rather than rubbing them. Use a moisturizer afterwards.
Handwashing with Alcohol-Based Sanitizers: Other Helpful Hints
* Leave the jewellery at home! Wear your adornments away from your hands as much as possible, and if you know you will be in a place where frequent handwashing will be necessary, opt for watches worn on brooches or pendants, pocket watches or the clock on your phone or other portable device. If you must wear rings or other jewellery, remove it during washing and then wash it as well before putting it back on.
* Keep nails short, and if you wear nail polish avoid chipped polish. Avoid wearing fake nails.
* Even if you are going somewhere that should have dispensers, carry your own bottle of sanitizer. When I was at the hospital the first three dispensers I came to were empty, and the fourth had only enough for one or two people to wash. You may find supplies run out faster than staff can replace them. Do ask for them to be replaced if you notice this, but be prepared too!
* When selecting an alcohol-based hand sanitizer, choose one with at least 60% alcohol. If it irritates your hands, discontinue use and find another brand that you better tolerate.
* If your hands are visibly soiled wash with soap and water. Proteins interfere with the effectiveness of the alcohol. If you’re stuck somewhere without water, scrub your hands off really well with a paper towel before using the sanitizer.
“Half of SGH doctors don’t wash their hands” The Star Online
“Information about Hand Hygiene” CHICA-Canada, Community and Hospital Infection Control Association
“Nosocomial infection” Wikipedia
“One third of doctors don’t wash hands” Richard Hartley-Parkinson (The Bucks Herald)
“Some Montreal doctors treat patients without washing hands: audit” CBC News
“Study: doctors don’t wash hands enough” WebMD