# What's wrong with this idea to encourage handwashing in hospitals? **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [January 24, 2011, 5:27pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805 "2011-01-24T17:27:01Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![EvilTOJ](https://avatars.discourse-cdn.com/v4/letter/e/ee59a6/32.png) [@EvilTOJ](https://boards.straightdope.com/u/EvilTOJ)\ **Post date:** [January 25, 2011, 8:30am UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/41 "2011-01-25T08:30:17Z")
They’ve already invented such a device. Relevant [del]xkcd[/del] [farside](http://steelwhitetable.org/media/images/didnt-wash-hands.jpg). ---
**Author:** ![anya\_marie](https://avatars.discourse-cdn.com/v4/letter/a/ebca7d/32.png) [@anya\_marie](https://boards.straightdope.com/u/anya_marie)\ **Post date:** [January 25, 2011, 9:34am UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/42 "2011-01-25T09:34:15Z")
As a former CNA I apprecaited being allowed to use the sink in the patient room to wash my hands. I couldn’t always use the antibacterial soap because it made my hands crack and ble ed and I brought something from Bath and body works to use. ---
**Author:** ![maisoui](https://avatars.discourse-cdn.com/v4/letter/m/85f322/32.png) [@maisoui](https://boards.straightdope.com/u/maisoui)\ **Post date:** [January 25, 2011, 12:32pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/43 "2011-01-25T12:32:45Z")
> [@Face\_Intentionally\_Left\_Blank](#): > > Does anyone know the process that the beds, handrails, telephones, remote controls, bedside table, etc go through to prevent the transmission of disease, in-between patients? What is done with the assorted items, and who does it? Always wondered about that. I will take a stab at this, although I’ve only worked as a unit clerk in the past and wasn’t in the patient’s rooms very much. Perhaps someone who has been in Housekeeping or in closer patient contact (or even someone who has worked on a unit more recently than I have) will come along with more info. This is Housekeeping. When a patient leaves, Housekeeping is notified to come and make the bed (and all assorted furniture, phone, tv, etc) ready for the next patient. There is a protocol they follow, and it is different depending on the circumstances. I remember that if the patient had tested positive in the past for one of the resistant bacteria (MRSA, VRE, etc) then a Terminal Clean was requested when they left. They would then use different products that weren’t used all the time so as to prevent even more resistance (in the same way that you don’t get antibiotics from your doctor if you don’t need them) and extra tasks would be performed, e.g. the drapes around the bed would be replaced, etc. Generally, though, the bed was removed and a new clean bed brought in for the sake of time. The beds themselves are cleaned thoroughly somewhere else in the hospital. The mattresses and pillows are actually covered in a plastic that is easier to clean than your soft ones at home. All of the hard surfaces are wiped down with whatever product was appropriate and the fixtures (toilet, sink, etc.) thoroughly cleaned. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 25, 2011, 1:56pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/44 "2011-01-25T13:56:20Z")
> [@corvidae](#): > > It would also alarm every time visitors walk in and out. I don’t know about the alarm thing (I can see it being disconnected due to people complaining about it), but maybe something focusing on how it’s not just “doctors and nurses” who should wash… how clearly does the signage in your school point that EVERYBODY should wash when entering/leaving a sickroom? I know my father’s BP shot every time he thought of the constant fight he kept with the cleaning staff re. “change the water and rinse/change mops/wiping papers for every single operating theater” - they saw absolutely no problem with using a single bucketful of water for all six. The part that made him angry is that many of the doctors didn’t either… he was the purchasing manager! ---
**Author:** ![mnemosyne](https://avatars.discourse-cdn.com/v4/letter/m/c4cdca/32.png) [@mnemosyne](https://boards.straightdope.com/u/mnemosyne)\ **Post date:** [January 25, 2011, 3:40pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/45 "2011-01-25T15:40:52Z")
> [@minor7flat5](#): > > Wow! I didn’t expect such fervor. > > (In response to your question, I have been working in big pharma for the past twenty years, admittedly not as a chemist, though with more than a layman’s knowledge of scientific processes in the drug pipeline) > > And I don’t disagree with your logic: for example, in work with folks in Drug Safety, I was amazed at the nature of metabolites in the body and how much diligence was placed on tagging and identifying every last scrap of stuff that turns up in a body after a drug is introduced—stuff that can be toxic even if the drug wasn’t. There are so many reasons why a good drug candidate can fail all along the pipeline. > > Given unlimited resources (e.g. typical $800million and 14y to make a new drug), I’m confident such a magic powder could be developed. > > Anyway, you are thinking too deeply about this: It was just a throwaway idea. I feel your most important point was that this “magic powder” would be a contaminant that really has no business being brought into hospital rooms. > > And the blacklight bit? That’s just for spot checks, once a week or once a month. It’s not like this special stuff would be used in every room daily. Heh, re-reading my post I did seem a little aggressive didn’t I? Truth is that I mulled it over for a while and typed it up over the course of a few hours as a homework distraction, and enjoyed the thought exercise. I always liked chemistry in theory…in practice it’s all pipettes and volumetric flasks and HPLCs and boring as hell. I say it would be more efficient to use the unlimited resources to hire someone to follow nurses and doctors around and scream “DIRTY HANDS!!” whenever they fail to wash their hands. ---
**Author:** ![Ike\_Witt](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ike_witt/32/283_2.png) [@Ike\_Witt](https://boards.straightdope.com/u/Ike_Witt)\ **Post date:** [January 25, 2011, 4:38pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/46 "2011-01-25T16:38:26Z")
> [@Leaffan](#): > > Just another alarming call system for the biomedical staff to maintain. I can’t see anyone installing one of these for any reason: cost, annoyance, repair. Nah. Ain’t gonna happen. I agree. There are already issues with noise in hospitals, one more alarm will just add to the ongoing din. ---
**Author:** ![StGermain](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/stgermain/32/2868_2.png) [@StGermain](https://boards.straightdope.com/u/StGermain)\ **Post date:** [January 25, 2011, 6:25pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/47 "2011-01-25T18:25:51Z")
I think having a dispenser/door handle would be the thing. You can’t open the door without having the sanitizer dispensed. StG ---
**Author:** ![irishgirl](https://avatars.discourse-cdn.com/v4/letter/i/8edcca/32.png) [@irishgirl](https://boards.straightdope.com/u/irishgirl)\ **Post date:** [January 25, 2011, 8:15pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/48 "2011-01-25T20:15:14Z")
I’m sorry to be Devil’s advocate, but simply entering a room (assuming you don’t touch the door handle, the patient or their surroundings) doesn’t magically mean that your hands are contaminated if they were already clean. Especially if you’re on rounds and have just sanitised your hands after leaving another patient’s area. The WHO 5 moments of hand hygiene are: Before touching a patient Before clean/aseptic procedures After body fluid exposure/risk After touching a patient After touching patient surroundings. One doesn’t have to re-sanitise hands BEFORE touching a patient’s surroundings, if one hasn’t touched anything AFTER sanitising. If one is merely going to stand in the room and talk to the patient (again, as commonly happens on rounds) without touching them or their surroundings there is no reason to sanitise if your hands are already clean. One shouldn’t sanitise more than 6 times in a row- you need to use soap and water every so often. If your hands are visibly dirty soap and water is also the only way to clean them, sanitiser won’t cut it. Also- in the case of an arrest -you’d probably not want that alarm sounding every time someone from the arrest team ran into the room, as usually they’ll have pulled on gloves en route, as they rather they didn’t waste 20 seconds with hand sanitiser if somebody needs resuscitating. Me, when I worked in hospitals I eventually had a small bottle of occupational health sanctioned special sanitiser on my belt or in my pocket, because the hospital one has chlorhexidine, which made my skin peel, so you’d never see me using dispensers. I was also allowed by some sort of special dispensation to use iodine for surgical scrubs, which made me happy- I love the smell! Now that I’m in general practice I can go a whole hour or more without touching a patient- lots of talking and very little examination in comparison to hospitals. I have a sink in my consulting room with my own choice of soap for handwashing- which is nicer than sanitiser or hospital soap, and the patients can watch me wash my hands, which is important. ---
**Author:** ![constanze](https://avatars.discourse-cdn.com/v4/letter/c/f9ae1b/32.png) [@constanze](https://boards.straightdope.com/u/constanze)\ **Post date:** [January 25, 2011, 8:49pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/49 "2011-01-25T20:49:30Z")
I saw some time ago a docu about the problem of bacterial infection in the hospital, and how to adress poor hygiene (in relation to super-resistant bacteria; and also when a few scandals turned up that not all German hospitals are required to have a full-time paid hygiene expert). They showed a procedure in one hospital where the hygiene expert would take a group (of nurses only, though), and have them do their routine procedure in a special teaching room. The surfaces were dabbed with harmless bacteria. Then a light was shined onto the hands of the people, and onto the surfaces in the room, to show how far bacteria had been spread. I doubt that psychologically a technical solution will get high compliance from personnel who either dislike too-much handwashing because it damages the skin, or for other dumb reasons. A drastic show-and-tell example has a better chance of convincing people, and if a full-time hygienist regularly checks procedures with different methods, and different groups, then those who improve can be seperated from those who are obstinate (who should not keep working in that field). That hygienist needs however a lot of power and clout to also adress the doctors and others. ---
**Author:** ![emmaliminal](https://avatars.discourse-cdn.com/v4/letter/e/7bcc69/32.png) [@emmaliminal](https://boards.straightdope.com/u/emmaliminal)\ **Post date:** [January 25, 2011, 9:09pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/50 "2011-01-25T21:09:24Z")
Two thoughts: First, pardon if anyone has already mentioned this but I didn’t see it on a fast read-through. Atul Gawande’s book \*Better \*has an essay on handwashing compliance. There’s versions of the essay available online, but those versions end before the part I think is most relevant here. [Google Books](http://books.google.com/books?id=hTKrkBmYKDQC&lpg=PA18&ots=np_BHNzvYt&dq=atul%20gawande%20hand%20washing%20employee&pg=PA26#v=onepage&q&f=false) should let you see it, though. Essay starts p. 13; part not usually online is pp. 19-27 with the best part starting p. 23. The key point is that handwashing compliance projects often don’t get much traction, but if you ask the people who need to wash their hands not "Why **don’t** you wash your hands?’ but “Why **can’t** you wash your hands?” – implying that people experience various obstacles to handwashing, which you are about to help them remove, not just that they’re lazy – and follow up on fixing what they talk about, compliance improves. Furthermore, it’s not the obstacle-fixing itself that is necessarily responsible for the improvement, but the engaging of people in coming up with their own solutions that does it. The automated system would, in keeping with these ideas, work best if the staff come up with it themselves or at least choose it. If you impose it without their general endorsement, it’s likely the staff will find ways to circumvent it. Second point: I think it’s much more likely to work with some kind of fine-tuning of the alarm function. As noted several times above, there’s a hell of a lot of random alarm noise in your average hospital room already, and anyone who works there has to have developed a tuning-out mechanism to survive. ---
**Author:** ![Derleth](https://avatars.discourse-cdn.com/v4/letter/d/b9e5f3/32.png) [@Derleth](https://boards.straightdope.com/u/Derleth)\ **Post date:** [January 25, 2011, 9:13pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/51 "2011-01-25T21:13:18Z")
[Hand sanitizers apparently aren’t effective, anyway.](http://www.slate.com/id/2245896/) ---
**Author:** ![Derleth](https://avatars.discourse-cdn.com/v4/letter/d/b9e5f3/32.png) [@Derleth](https://boards.straightdope.com/u/Derleth)\ **Post date:** [January 25, 2011, 9:21pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/52 "2011-01-25T21:21:15Z")
[More about hand ‘sanitizers’.](https://www.nytimes.com/2006/03/21/health/21cons.html) [A somewhat different view, but still not promising](http://edis.ifas.ufl.edu/fy732): > [@](#): > > Hand sanitizers should primarily be used only as an optional follow-up to traditional hand washing with soap and water, except in situations where soap and water are not available. In those instances, use of an alcohol gel is certainly better than nothing at all. Damning with faint praise. In short, they look like another scam, just like ‘antibacterial’ soaps. ---
**Author:** ![emmaliminal](https://avatars.discourse-cdn.com/v4/letter/e/7bcc69/32.png) [@emmaliminal](https://boards.straightdope.com/u/emmaliminal)\ **Post date:** [January 25, 2011, 9:23pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/53 "2011-01-25T21:23:53Z")
> [@Derleth](#): > > [Hand sanitizers apparently aren’t effective, anyway.](http://www.slate.com/id/2245896/) I think you missed the point of that article, which (while it mentions problems with handwashing compliance in health-care settings) mostly says sanitizers don’t stop disease transmission _in non health-care settings,_ such as homes and schools. Specifically, sanitizers don’t do much to stop flu, which is transmitted more by air than by hand. I don’t have a cite handy, but it’s my understanding that in healthcare settings, sanitizers are equal to or better than soap-and-water as actually used, as opposed to as optimally used. ---
**Author:** ![emmaliminal](https://avatars.discourse-cdn.com/v4/letter/e/7bcc69/32.png) [@emmaliminal](https://boards.straightdope.com/u/emmaliminal)\ **Post date:** [January 25, 2011, 9:26pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/54 "2011-01-25T21:26:28Z")
> [@Derleth](#): > > [More about hand ‘sanitizers’.](https://www.nytimes.com/2006/03/21/health/21cons.html) And that article says 60%+ alcohol sanitizers work great on not-visibly-dirty hands, while lower-strength ones don’t. ---
**Author:** ![Derleth](https://avatars.discourse-cdn.com/v4/letter/d/b9e5f3/32.png) [@Derleth](https://boards.straightdope.com/u/Derleth)\ **Post date:** [January 25, 2011, 9:37pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/55 "2011-01-25T21:37:17Z")
> [@emmaliminal](#): > > And that article says 60%+ alcohol sanitizers work great on not-visibly-dirty hands, while lower-strength ones don’t. As the politician said, you go the hospital with the sanitizers you _have_, not the sanitizers you _want_. Maybe _you’ll_ be the one to ensure all hospitals only use the correct sanitizers, _and_ that all sanitizers are labeled to preserve health, as opposed to profit margins. ---
**Author:** ![emmaliminal](https://avatars.discourse-cdn.com/v4/letter/e/7bcc69/32.png) [@emmaliminal](https://boards.straightdope.com/u/emmaliminal)\ **Post date:** [January 25, 2011, 9:54pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/56 "2011-01-25T21:54:11Z")
> [@Derleth](#): > > As the politician said, you go the hospital with the sanitizers you _have_, not the sanitizers you _want_. Maybe _you’ll_ be the one to ensure all hospitals only use the correct sanitizers, _and_ that all sanitizers are labeled to preserve health, as opposed to profit margins. Well, in my experience, after the studies and that article came out (five years ago), it became tough to even find sanitizers with less than 60% alcohol. And I would be surprised indeed to find a hospital that thought its profit margin was better served by an increase in hospital acquired infections than by the difference between low-strength and normal-strength alcohol sanitizers. See **WhyNot** ’s [link](http://boards.straightdope.com/sdmb/showpost.php?p=13389784&postcount=7) in #7. ETA: True, this all does assume that stuff labeled 60%+ really is 60%+ most of the time. Got me there. ---
**Author:** ![JoelUpchurch](https://avatars.discourse-cdn.com/v4/letter/j/f05b48/32.png) [@JoelUpchurch](https://boards.straightdope.com/u/JoelUpchurch)\ **Post date:** [January 25, 2011, 9:58pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/57 "2011-01-25T21:58:18Z")
I read Atul Gawande’s book, _The Checklist Manifesto: How to Get Things Right_. IIRC, the worst problems were doctors, not nurses. The nurses were more likely to follow the procedures. I think one thing they did was to give out cash prizes to hospital staff that reported doctors not following the rules. ---
**Author:** ![JoelUpchurch](https://avatars.discourse-cdn.com/v4/letter/j/f05b48/32.png) [@JoelUpchurch](https://boards.straightdope.com/u/JoelUpchurch)\ **Post date:** [January 26, 2011, 3:42am UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/58 "2011-01-26T03:42:57Z")
Here is another approach being tried at the University of Massachusetts Medical School. [http://www.telegram.com/article/20110122/NEWS/101220361/1116](http://www.telegram.com/article/20110122/NEWS/101220361/1116) ---
**Author:** ![Kerrigan](https://avatars.discourse-cdn.com/v4/letter/k/49beb7/32.png) [@Kerrigan](https://boards.straightdope.com/u/Kerrigan)\ **Post date:** [January 26, 2011, 3:54am UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/59 "2011-01-26T03:54:56Z")
I’ll add another vote as a nurse who doesn’t use the sanitizer every single time, and is still complying with the rules. If I wash my hands with soap and water at the sink inside the patient’s room according to CDC guidelines before leaving the room, and immediately proceed to leave the room, I am not required to use alcohol-based hand sanitizer at that time. Nor do I want to–I often feel more like I’m washing off all the gel and foam’s residue when I use water than I am ridding my skin of bacteria. Someone else made another good point. If I am taking care of two patients, in rooms 1 and 2, it is not at all uncommon for me to perform care in room 1, disinfect on my way out, and take 3 or fewer steps to enter into room 2 without disinfecting at that time. In fact, by the time I enter room 2 I may still be rubbing the foam or gel into my skin. Another moment when I’m sure not about to push that dispenser again. Noise level is a valid concern that has already been adequately addressed. I know that in the critical care unit in which I work, the noise level at night is the #1 complaint on our patient satisfaction surveys post-discharge. Adding another alarm (which yes, would be constant) would entirely fail to help. ---
**Author:** ![Face\_Intentionally\_Left\_Blank](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/face_intentionally_left_blank/32/288_2.png) [@Face\_Intentionally\_Left\_Blank](https://boards.straightdope.com/u/Face_Intentionally_Left_Blank)\ **Post date:** [January 29, 2011, 9:42pm UTC](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805/60 "2011-01-29T21:42:47Z")
> [@maisoui](#): > > I will take a stab at this, although I’ve only worked as a unit clerk in the past and wasn’t in the patient’s rooms very much. Perhaps someone who has been in Housekeeping or in closer patient contact (or even someone who has worked on a unit more recently than I have) will come along with more info. > > This is Housekeeping. When a patient leaves, Housekeeping is notified to come and make the bed (and all assorted furniture, phone, tv, etc) ready for the next patient. There is a protocol they follow, and it is different depending on the circumstances. I remember that if the patient had tested positive in the past for one of the resistant bacteria (MRSA, VRE, etc) then a Terminal Clean was requested when they left. They would then use different products that weren’t used all the time so as to prevent even more resistance (in the same way that you don’t get antibiotics from your doctor if you don’t need them) and extra tasks would be performed, e.g. the drapes around the bed would be replaced, etc. > > Generally, though, the bed was removed and a new clean bed brought in for the sake of time. The beds themselves are cleaned thoroughly somewhere else in the hospital. The mattresses and pillows are actually covered in a plastic that is easier to clean than your soft ones at home. > > All of the hard surfaces are wiped down with whatever product was appropriate and the fixtures (toilet, sink, etc.) thoroughly cleaned. I’m a little late getting back here, but I wanted to thank you for the reply. I knew nothing about this. [Previous page](https://boards.straightdope.com/t/whats-wrong-with-this-idea-to-encourage-handwashing-in-hospitals/568805.md?page=2)