Wash Those Hands!

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Nearly 10% of Americans who are admitted to a hospital pick up an infection while they are there. Sometimes the culprit is a germ that they've brought with them to the hospital — typically some bacteria on the skin that follow the path of a needle or catheter into the body. But most hospital infections are transmitted from one patient to another by doctors, nurses and other health-care workers. No, doctors and nurses aren't carrying around vials of disease-causing bugs and cracking them open at bedside. Often the germs are hitching a ride on the hands of hospital workers.

The results can be catastrophic. Hospital infections contribute to the deaths of nearly 90,000 patients in the U.S. each year and add about $4.5 billion to medical costs. And yet the solution can be as simple as a bar of medicated soap or a disinfectant alcohol rub. "Improved hand washing can reduce rates of infection as much as a third," says Elaine Larson, an expert on health-care hygiene at the Columbia University School of Nursing. Even wearing latex gloves isn't necessarily a good substitute, since taking them off improperly can lead to recontamination.

Unfortunately, health-care workers don't seem to be getting the message. Or if they are, they're not very consistent about putting it into practice. Study after study has shown that hospital staff generally follow hand-washing guidelines less than 40% of the time — sometimes a lot less. (A couple of small studies suggest that nurses may be better than doctors at washing their hands, but nobody's perfect.)

Many states require that newly built hospitals have at least two sinks per room — one for the patient, another for the medical staff (who might otherwise feel they were intruding by using the patient's sink to wash their hands). In January researchers at the Mayo Clinic College of Medicine in Rochester, Minn., recommended that health-care workers carry alcohol hand rubs in their pockets to make disinfecting easier. Lately some hygiene experts have suggested that patients ask doctors and nurses whether they've washed their hands before an examination begins.

How do you do that without putting your caregiver on the defensive? One approach, suggests Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, "might be to say, 'I've read that it's important for health-care professionals to wash their hands frequently — and that doctors are so busy they sometimes forget.'" It probably helps to smile when you say that.