Should patients be responsible for physician handwashing?

Should patients be responsible for physician handwashing?

Hospitals struggle to get doctors and nurses to wash their hands. That’s a serious problem, since hand washing is one of the keys to reducing healthcare acquired infections that afflict more than a million patients a year and kill over 100,000. And it’s one of the reasons you should try your best to stay out of the hospital.

For the past few years I’ve heard suggestions that patients should take a more active role, and in fact have the responsibility to speak up. The Wall Street Journal (Why Hospitals Want Patients to Ask Doctors, ‘Have You Washed Your Hands?’) covers the topic again, with a pretty strong message that patients need to take charge.

I strongly disagree.

Here’s one excerpt from the article:

The CDC has provided 16,000 copies of a video, titled “Hand Hygiene Saves Lives,” to be shown to patients at admission. In one scenario, a doctor comes into a room and the patient’s wife says, “Doctor, I’m embarrassed to even ask you this, but would you mind cleansing your hands before you begin?” The doctor replies, “Oh, I washed them right before I came in the room.” The wife says, “If you wouldn’t mind, I’d like you to do it again, in front of me.”

And here’s another:

“We’ve been focusing on intensive interventions to improve hand hygiene among health-care workers for decades, yet we’ve really shown very little progress,” says Carol McLay, a Lexington, Ky., infection prevention consultant and chair of the committee that designed the campaign [to get patients to speak up]. “We are trying to empower patients and families to speak up and understand their role.”

Am I the only one that thinks the situations described above are absurd?

Here’s how I see it:

  • If infection control specialists have been failing to make progress with health care workers for decades then they need to figure out what’s wrong and fix it, not throw the problem onto patients. Here are some ideas: education to get more buy-in from clinicians on the idea of frequent hand washing, technology to track whether hand washing is occurring, harsh penalties for lack of compliance — like closing down a hospital floor, or firing or suspending staff, or making lack of hand washing subject to malpractice claims. If you believe the conventional wisdom (which I don’t — but that’s another story) then physicians will be so focused on avoiding lawsuits through defensive medicine that they’ll instantly get to 100% compliance on hand washing.
  • The scenario in the video of first asking a doc if he washed his hands  – and then not accepting his answer that he just did it but instead wanting to see him “cleanse” his hands again — is ridiculous. That’s not my vision of patient engagement.
  • Lack of hand washing is reasonably visible to the patient, but what about all the other things that occur? Is it practical to verify that my doctor performed all the correct diagnostic tests, interpreted the results correctly, made the right differential diagnosis, prescribed the most appropriate antibiotic and dosing level,  that the hospital stored the medications properly and disinfected their equipment, that the nurses didn’t fake their credentials and that their immunizations are up to date, that I was referred to the right specialists, etc.? All of these things — and many, many others — are important, but I count on the hospital to deal with it and the regulators to oversee that it’s done. I want quality ratings that take into account these issues and I don’t mind payment incentives that reward certain behaviors and penalize others.

Don’t get me wrong. I hate the idea of doctors and nurses not washing their hands. If I’m in the hospital and I see something I’m unsure of I do speak up. I bring an advocate when I’m a patient and act as one for others. I would even bring up hand washing in certain circumstances.

But I really resent the idea that I’m supposed to be the handwashing police. Hire someone else to do the job.

David E. Williams is president, Health Business Group and blogs at the Health Business Blog.

Image credit: Shutterstock.com

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  • http://barefootmeds.wordpress.com/ Barefootmeds

    In our paediatric wards, parents are encouraged to ask doctors and med students to wash their hands if they don’t see them doing it. Every room has a basin though, so it’s easy to see.
    But in general, frankly, the doctor is responsible for washing his hands. I don’t think patients should have to take that responsibility.

  • bojimbo26

    It’s the Drs and students responsibility .

  • NormRx

    “Since hand washing is one of the keys to
    reducing healthcare acquired infections that afflict more than a million
    patients a year and kill over 100,000.”

    And yet, reading the post by some physicians on this web site, GUNS ARE THE PROBLEM!!!!

    • guest

      Oh, right. Guns are definitely not a problem at all, because handwashing is…

  • guest

    Just another government policy designed to create an adversarial relationship between patients and their doctors.

    If the CDC is interested in handwashing (and we all should be interested in handwashing) then they should do a study to determine the barriers to better compliance, and get involved with a meaningful solution based on whatever those barriers are.

    But, since it’s this administration, what we get is an assumption that doctors are “bad,” and that the solution is that they should be scolded.

  • Noni

    Ha, I’m a physician, and whenever a practitioner came into contact with my children I was so tempted to ask them to wash their hands but I felt too awkward about it. If I, an insider, felt uncomfortable asking I can’t imagine how a typical patient would feel asking their doc to wash their hands.

    • EmilyAnon

      Noni, you are so right about patients feeling awkward questioning their caregivers about hand washing, or any other hygiene matters.

      There have been times when the doctor, gloved, went out the door and back, open and closed cabinets, reached into their pocket for something, all the while wearing the same gloves they examined me with later. I even had a gyn, gloved, check a text message, then proceeded with the exam. Even with all that I couldn’t bring it to their attention without fear of alienating them. Because once I spoke up after reading an article about germs being on stethoscopes. When I asked one of my doctor’s if he cleaned his, he bristled and scoffed at the possibility of any danger. To my knowledge I’ve never caught anything so far, but sometimes l feel like showering immediately when I get home.

      • Karen Freitag Franz

        I was visiting a patient and she had a large stage IV pressure ulcer and was vent dependent. The caregiver came in the room, put on gloves,suctioned the trach and then proceded to try to change the dressing with the same gloves. I asked her to change her gloves and she was an unhappy camper. After she changed the drsg. she went to the in-wall computer screen and charted with the soiled gloves on her hands. So now anyone who uses the computer will be contaminated with pseudomonas. I am an RN, so I am not nurse bashing. Isn’t some of this common sense?

  • drunkenpastor

    WHAT the hell is it that is so magical about being in a hospital that suddenly makes everyone suddenly the hand washing police? These patients are the same ones that go take a leak and head straight out the bathroom door, opening the door with same hand they used on their genitals. I’ve watched our kitchen cooks and workers do the very same thing, and the go straight back to the food assembly line.

  • Disqus_37216b4O

    Should it also be the responsibility of air passengers to make sure their pilot and crew haven’t been drinking?

    You would hope that both patients in a hospital and passengers on a plane could have some confidence that there were safety systems in place for their protection, without them being asked to be responsible for policing them themselves.

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