
Why most doctors don't wash their hands - bookofjoe
https://www.3quarksdaily.com/3quarksdaily/2020/08/why-most-doctors-dont-wash-their-hands.html
======
savanaly
The only thing the article does to address the topic of the headline is
include this link [0]. The rest is a combination of anecdote about a doctor
failing to wash his hands and history about hand washing.

[0]
[https://www.ncbi.nlm.nih.gov/books/NBK144026/table/parti_ch1...](https://www.ncbi.nlm.nih.gov/books/NBK144026/table/parti_ch16.t3/?report=objectonly)

~~~
beervirus
Seriously. Reading that title, I expected an article about some
counterintuitive reason that it’s _better_ for doctors not to wash their
hands.

I have to believe most doctors, by far, do wash their hands.

~~~
rconti
My wife's an occupational therapist (so, should be lumped in with the PTs who
are "less likely to wash their hands") and she's pretty religious about hand
washing, keeping work clothes separate, changing shoes when she leave the
hospital, etc. I have to imagine it's cultural from the various facilities
she's worked in, because she's not otherwise (outside of post-work) a
germophobe or anything.

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tetrometal
> There was an awkward silence. I expected him to offer a feeble excuse. Blurt
> out that the woman was crazy, or that she was talking nonsense. Get
> defensive, say he used the had-rub solution outside her room or washed his
> hands at the sink by the nurses’ station. But he did none of that. “Tell her
> I’m sorry,” he said instead. “I’ll ask my colleague to take over her care.”

I wish behavior like this was more celebrated. It's incredibly rare and
incredibly difficult.

~~~
sushisource
Agreed. It is shocking to me how rare simply accepting fault is. Maybe, 10% of
the time, at best? I wish there were some better incentives to actually behave
that way consistently. I often find myself thinking "Man, why am I even trying
to be nice or do the right thing here when all these other assholes meander
selfishly through life and have great outcomes too?"

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mbubb
I would be really interested in reading a article on "why doctors don't wash
their hands" but this ain't it. Interesting stuff on Seimmelweis but otherwise
fluff.

I am an EMT and was on a particularly bloody call and noted the paramedic was
not wearing gloves... Part of it might be related to the joke that ALS stands
for "Aint lifting shite" but if I had more time on the call I might have asked
him...

The use of PPE and washing hands are interesting topics and am often
interested in things I see wrt this.

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brazzy
I have read the story of Ignaz Semmelweis many times, and pretty much always
it is framed as the abhorrent injustice of a comically evil establishment
resenting and destroying a saviour-figure out of sheer bloody-mindedness.

This is the first time I have seen sensible explanations, namely that
Semmelweis was really bad at promoting his discovies and successes:

> It did not help that Semmelweis was a tactless, difficult, and angry man who
> lacked people-skills. For one, years after his research, he refused to
> publish his findings and reasoning, because he considered it ”self-evident.”
> Further, he openly berated even the most powerful doctors who dared to
> challenge him or failed to wash their hands.

~~~
Nasrudith
Really that is still on society for being so fucking insane that they care
more about their petty delusions od hierarchies and egos than lives of
mothers.

To put it on him is a vile form of victim blaming and tone policing, a tactic
of vile bullies to in defiancr of all justice and logic insist it is the fault
of the victim for being upset at an outrage. The self evident should be
especially obvious given the number of deaths from botched autopsies and self
inflicted wounds around corpses. Only an absolute monster would shove a corpse
part in the loins of a new mother but they were effectively doing the same
thing when even stray cuts could kill. Semmelweis was the only sane man by
being so furious. Others were making blood sacrifices to the gods of social
norms.

~~~
brazzy
Thanks for proving my point so impressively.

That is not how you make the world a better place. You don't change people's
behaviour by villifying and verbally abusing them. _You_ are fully prepared to
make blood sacrifices to your own imagined moral superiority.

------
ALittleLight
I'm torn between thinking maybe being shamed by your colleague taking you off
a case is an effective punishment and believing that doctors should face more
serious punishments for hand washing failure. A doctor failing to wash hands
is probably inflicting a similar societal danger as driving drunk - people
really could get hurt or die. It doesn't seem like the kind of thing that
should just be shrugged off.

The point about hand gel is a good one. I have containers of Purell and find
that I enjoy washing my hands with it much more than with soap and water. I
actually think of Purell as a slight positive, writing this, I'm considering
Purelling my hands just for fun. I think this is probably the best
technological solution: make sanitizing hands a fun experience that people
want to do rather than a slight cost that people often ignore.

Another potential solution might be applying some kind of coloring agent to
hospital surfaces so that doctors who haven't washed in a bit will get
increasingly red hands. That's probably less desirable though.

~~~
fuzxi
The coloring agent idea is neat, but seems infeasible to me. You'd end up
staining documents, clothes, and whatever else, plus you'd have to dedicate
custodial staff to reapply it.

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jldugger
A lot of discussion about Semmelweis, but the actual reasons:

"Some factors that hindered hand-washing were days with busy workload and a
feeling of not being watched.

A World Health Organization (WHO) report has also listed other barriers to
adherence with hand-washing guidelines, including:

    
    
      Working in the ICU, surgical unit, or emergency rooms
      being a nursing assistant (rather than a nurse), or physical therapist
      Sinks are inconveniently located/shortage of sinks
      Lack of soap and paper towels
      Male sex
      Handwashing agents cause irritation and dryness
      Understaffing and overcrowding
      Wearing gloves and the belief that using gloves avoids the   need for hand hygiene
      Not thinking about it/forgetfulness
      No role model from colleagues or superiors
      Skepticism regarding the value of hand hygiene
      Disagreement with the recommendations"

~~~
nick_kline
What is 'male sex'? Something about men don't want to be seen as washing their
hands too much or?

~~~
mbubb
thought the same thing - men not washing hands after nookie? And whats this
about sinks being too short? Distractingly crappy data categories.

~~~
munk-a
As a certified tall person I can confirm I am less willing to do things low to
the ground. So sinks being too short seems legitimate. I do understand the
other side (short people) have it harder though - if a sink is too tall for
you then it's pretty much impossible to use.

Also, male sex is referencing being of the male gender it has nothing to do
with intercourse. Feel free to question the legitimacy of the category, but
the category itself is pretty clearly defined.

~~~
kps
> So sinks being too short seems legitimate.

Before people get too carried away with this, it said “ _shortage of sinks_ ”.

~~~
mbubb
yes - bad joke in the vein of "male sex" \- the categories are sloppily
generated in the WHO example. But you are right - the sinks are in short
supply...

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fuzxi
This caught my eye, from the article:

>A World Health Organization (WHO) report has also listed other barriers to
adherence with hand-washing guidelines, including:

>[...]

>Sinks are inconveniently located/shortage of sinks

>Lack of soap and paper towels

>Male sex

>Handwashing agents cause irritation and dryness

Uh, what? One of these things does not belong.

I was actually curious about this, so I followed the link to the WHO report.
It cites two studies as evidence of "male sex" being a factor affecting
handwashing adherence. I looked through the full text both of those studies,
and...they make no mention of any such thing. One has zero instances of the
term 'male' or 'man', the other has three as it comments on the demographics
of the studied _patients_.

All this to say...where did this supposed factor come from?

~~~
pfg
Both studies[1][2] mention doctor's sex as a factor. "Effect of education and
performance feedback on handwashing: the benefit of administrative support in
Argentinean hospitals", for example, has these figures (calculated as Number
of handwashings/Number of opportunities [to wash their hands?]):

> Male vs female: 46% (1989/4350) vs 53% (5895/11,181)

[1]:
[https://pdfs.semanticscholar.org/f3c8/bb1914d5226c719df53dd8...](https://pdfs.semanticscholar.org/f3c8/bb1914d5226c719df53dd864e675d5061d4a.pdf)

[2]:
[https://pdfs.semanticscholar.org/8887/835e725b4347a5392e095a...](https://pdfs.semanticscholar.org/8887/835e725b4347a5392e095a81ae2087f6d957.pdf)

~~~
fuzxi
Thank you! I thought I must have been missing something. I have no clue why my
ctrl+f returned only 3 results for the second study. I just trusted that the
searches were accurate because the abstracts didn't mention sex as a factor.

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mbubb
There is a lot of confusion about PPE and disinfecting. People wear surgical
masks thinking they are making themselves safe - which they arent. I think
also people use magical thinking with disinfectants.

I remember one EMT call where my partner got blood on her arm. She impulsively
reached for the handsantizer but I told her to wait. Took her back to the
hospital (we just left) and let her wash with soap.

I felt in the moment like an alcohol based wash would just irritate her skin
and open pores or perhaps breakdown the skin . When the alcohol evaporates
much of the crud would still be there whereas washing with soap feels like you
will better handle the issue with surfactant. Might have been wrong.

~~~
jiofih
I would guess that having infected blood on you, and potentially smeared in
your car and other places, is quite a lot worse than drenching it in alcohol
even if not fully cleaned. Why not both?

~~~
bookofjoe
I wiped a LOT of blood — infected and not — off my fingers, hands, and arms in
the course of practicing neurosurgical anesthesiology for 38 years (now
retired).

I'd guess hundreds of times.

Often — especially nights and weekends — there's no other anesthesiologist
available to come to the O.R. for relief and a chance to wash it off.

In those cases, I'd ask the circulating nurse to get a bunch of towels and run
them under hot water at the scrub sink, then give them to me to wipe off as
best I could.

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zebrafish
I thought most hospitals had hall monitors who were writing people up for not
foaming in and out of each room. Maybe that's not everywhere or is just
university hospitals.

~~~
mikestew
I unfortunately spent a good deal of time in hospitals from last Christmas
(yes, literally Christmas) to mid-March. I noticed no hall monitor even at the
university hospital, and having read _The Checklist Manifesto_ , out of
curiosity I was paying attention to hand washing. As I recall, most if not
all washed hands as one would hope.

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nullc
If there was interest in achieving high compliance and the expect reduction in
mortality, why wouldn't it be sufficient to randomly spot check hospital staff
hands for infectious agents and have a program of escalating fines then
suspensions followed by loss of license for persons who are consistently
above-threshold?

The aggressiveness could be gradually increased over time to prevent a
disruptive loss of workforce given the existing poor practices.

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mech4bg
I was not impressed with the lack of handwashing at our local hospital. Last
time I was there I noticed they'd put up signs encouraging patients to ask
their care provider if they'd washed their hands. I had a nurse come out,
bring me in, then start putting in an IV without washing his hands. I asked
him if he'd washed his hands and he very quickly answered "yes" and put the
line into my vein - while I was calculating the number of doors and surfaces
he'd touched coming out to get me and then lead me into the interior rooms. It
was excruciating asking him about that.

Most of my doctors visits seem to involve the doctor not washing their hands
when they come in, and then not washing their hands after examinations.

I am baffled by this behavior - you would think that they would know the best
how important hand-washing is.

It's wild in that article how hard he found it to give feedback to his
colleague about his hand-washing. As a patient I find it incredibly
uncomfortable mentioning it to medical staff, and yet it is so important.

I wish the article had actually done a deep dive into why this seems so
widespread and what could be done to change it.

~~~
stevehawk
If possible, I'd try to find another hospital/doctor. My wife (breast cancer
surgeon) has the worst skin in the world and it's because she's adamant about
washing her hands as she walks into a room and as she walks out of the room
(even before COVID). Meanwhile, I have these dainty soft keyboard hands that
she is envious of. But, it's not just that she's strict about it, it's that
her hospital as a whole is strict about it and minimizing post-op/wound
care/consult infections. It's bad for the patient and it's bad for the
hospital (re: not profitable).

~~~
mech4bg
I've seen it at multiple medical facilities here unfortunately. Maybe it's a
Portland thing?

~~~
stevehawk
it's possible. it's a change that has to start at the top and most hospitals
in an area tend to be owned by the same company

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findyoucef
This is absolutely horse shit. My mom is a provider and has always washed her
hands before and after every patient. If they're not there is something very
wrong with them.

~~~
fuzxi
The article did include a link to a study [1] about the low rates of
handwashing among doctors and nurses. Although the article neglects to note
the second line in the abstract's conclusion heading:

>In general, the study methods were not very robust and often ill reported.

[1] [https://www.cambridge.org/core/journals/infection-control-
an...](https://www.cambridge.org/core/journals/infection-control-and-hospital-
epidemiology/article/systematic-review-of-studies-on-compliance-with-hand-
hygiene-guidelines-in-hospital-care/36AD78694A4A2BA831A598E9C935C92E)

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sjg007
I’ve seen this a lot. It’s sad.

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m3kw9
I think doctors don’t wash their hands is like someone who is adapt at washing
dishes to know when soap is not needed to wash certain dishes to be good
enough to not get you sick. They take a chance but save them a little time. Of
course if they just accidentally came in contact with a patients private parts
or something “wet” they are most likely to.

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scott31
Doctors are motivated only by their income, and since washing hands won't add
to that, they see it as waste of time in which they could "treat" another
patient

~~~
munk-a
Getting the premiums on your malpractice insurance is certainly a strong
effect on your income - if they were intelligent actors they would foresee
this and wash their hands.

This is just plain old stupidity.

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wombatmobile
Does anyone ever really know why anyone (including the self) really does or
does not do anything?

We can all offer a narrative, but that’s just our confabulation module
narrating post hoc. The split brain experiments proved that to be the case.

We are all just advanced versions of GPT3.

Discuss

~~~
bdamm
Why we act at all is not relevant here. The fact is that policy and training
produce behavioral outcomes. So if you want to change a behavior in a group of
employees, you can train them. What to train them on, how to train them, and
how to encourage adherence to the training are the subjects here. You can
choose to spend your energy in philosophy or psychology but that's too big a
question if you just want to understand how and why doctors wash their hands.

~~~
wombatmobile
> What to train them on, how to train them, and how to encourage adherence to
> the training are the subjects here

Yep.

The fact that enough doctors are in breach of the protocol, despite all the
training and motivators, suggests we do need to look deeper.

I'm not sure why you would reject psychology or neuroscience insights into the
causes of behavior. Aren't those the disciplines that provide a scientific
basis for constructing training protocols? Philosophy just tells us that the
scientists are limited by conscious awareness, which means they don't have
access to the data to be able to determine themselves why they do or don't
make a behavior.

