What is doctors’ compliance rate for hand hygiene procedures?

According to a new study, when they know they are being watched it is 57 percent.

When they don’t know they are being watched, it is 22 percent.

What I find shocking is not the difference, which fits readily into the economic way of thinking.  It is that direct observation of doctors still does not get the rate above 57 percent.

Comments

It doesn't surprise me. There are a thousand and one jokes about the arrogance of doctors. Including the famous one that ends "God doesn't think He is a doctor".

However I would be a little cautious of the 57% figure. It may be that not all procedures needed the full lathering procedure using alcohol. Doctors might be making sensible decisions when left on their own. We don't know and they did not check.

I always get a kick out people who argue that medical malpractice litigation is out of control and driving up healthcare costs and must be legislated against, and are then shocked by the studies showing high rates of medical error and high-handed and outrageous conduct by doctors and ask why there isn't some way to hold them accountable.

The risk of expensive litigation leads institutions to merely appear to comply, rather than leading them to innovate or solve them. Partly because lawsuits are related not to actual harm, but only to naive perceptions of culpability and the capacity to pay.

And your evidence for any of that is ?

And your evidence of, ... what ever the hell you are thinking is?

I am not shocked. By all means we should reduce medical errors and high handed conduct by doctors.

But what is actually going on here? It is not obvious that there has been high handed conduct by anyone. There is no evidence of any medical errors. just a culture of ticking boxes.

It gets worse when the doctor insists on shaking your hand at the end of the examination, presumably thinking this will make you feel better. And dont forget the dangerously dangling tie, that's a real problem because the tie (unlike the shirt) hardly ever if ever gets washed. 2014 http://www.usatoday.com/story/news/nation/2014/01/21/doctor-dress-code-germs/4718253/ 2004 http://www.webmd.com/women/news/20040524/nasty-neckties-doctors-ties-carry-germs

Wasn't there a semi-joke about that, like don't worry about the toilet seat in the public restroom, but never shake your doctor's hand.

If you want to dig deeper on this, Ariely's book on dishonesty and the website : http://danariely.com/tag/the-honest-truth-about-dishonesty/ discuss this, have experiments, etc.

It's worth noting that the study talks about monitoring "healthcare providers", not doctors. Depending on their definition, this would included PAs/NPs, nurses, techs, and even food service and environmental.

I've been on a few committees at different hospitals where this was discussed, and in general nurses > MDs/PAs >>> everyone else.

Never shake hands with a proctologist.

A b.s. story. Didn't TC link to an article that found washing hands is not that effective anyway? The one that said towels are better than air blowers. Anyway, even Philippine hospitals now have 'hand sanitizers' of alcohol next to elevators, and I assume surgeons wear gloves when the open up patients, so this article is a bit misleading, though I do recall the dentist(s) who were sued for spreading AIDs by not changing their gloves between patients (it was a speculative lawsuit anyway, since the AIDS virus is hard to if not nearly impossible to transmit with your hands as it doesn't survive long outside the bloodstream.

Two in a row (AlexT, TC) junk science posts from people (economists) who wish they were scientists. Physics envy?

Pretty sure the article that said towels are better than blow dryers said the exact opposite of that, that hand washing is effective and that paper towels contribute to its effectiveness.

Cliff, you wrote a single sentence and it is self-contradicting.

To be fair, the consistncy Cliff's sentence is undecidable without reference to the paraent comment. So it is not exaclty "self contradicting".

It's just wrong.

When management invents protocols disconnected from reality of practice, they fail. Shocking.

When management invents protocols that are inconvenient to doctors, they fail. Shocking!

Always felt a good innovation would be a visual/audio signal outside hospital restrooms. If a toilet flushes and no water runs in the sink before the door opens, the alarm goes off.

Why don't they have to wear plastic gloves? A new pair for each patient? Like food service workers?

Why on earth do people shake hands. Hands are filthy. I don't wish to touch anybody's hands, and I don't care if they washed them with bleach. What a silly custom. As I understand it, the custom arose as a way to show the person you are greeting that you aren't holding a weapon. If it's a concern that people suspect you are holding a weapon, why not simply hold out your arms with the palms face up. That way she will know you don't have a weapon and she might even think you are soliciting a donation and put $5 in your palm. Win, win. Of course, if she's a doctor, don't expect the $5.

Alright, I'll kiss you on the cheek then

This is a big reason why many Eastern cultures bow instead of shaking hands or cheek kissing. Way more sanitary.

I would think, that more than doubling the amount you do something is pretty good. Especially when you are only use to doing that activity on the regular at 22%!

Doctors aren't idiots. Their behaviors guided by a subconscious that is continually balancing benefits and assessing risks. Compliance rates reflect their professional judgment of the overall benefit of washing hands. Doctors really do want to "do no harm". If the overwhelming majority of doctors actually thought that hand washing protocols were a magic bullet against in-hospital infections, they'd be scrubbing their hands raw.

I don't disagree with this - in fact I said much the same further upstream - but I wouldn't go too far with it either. Yes, doctors are continually balancing benefits and assessing risks. But they are continually balancing benefits and risks to themselves. They don't get MRSA after all. Their patients do. But they have to wash their own hands. All things being equal doctors really do want to “do no harm”. But things are rarely equal.

In the end the medical profession is run for the benefit of doctors. Doctors do know that washing hands reduces the rate of MRSA infections. This has been well studied and well proven. They are not scrubbing their hands raw. Nor are they making sure that Emergency patients get the best care. Most of us, if we are rushed to hospital, get an inexperienced trainee who may not have slept for the past 36 hours. If on the other hand your grandmother wants a flu injection, she gets a well rested GP with decades of experience. That does not benefit the public. It benefits doctors - especially older, more senior doctors who like to play golf. Doctors know this. There is absolutely no pressure whatsoever to change it.

The attendings discuss with the residents and sign off on all of the cases. They have to learn somehow. If you don't want this, best to go to a non academic hospital.

I don't think this is the sort of thing that a doctor's clinical judgment is going to be useful in judging. In general, if you transfer a bug from me to some other patient, you're not going to know that you've done so. Your other patient will get sick and you'll end up treating it, but you won't know how they got it.

As I understand it (I'm definitely NOT an expert), when hospitals impose these hand hygiene procedures, the rate of patients catching something in the hospital goes down quite a bit. This looks like one of those situations where the only way to actually figure out what you should be doing is to do some statistics.

A lot of this depends upon who they monitor and what standards they use. For example in some situations we have found that if follow the hand washing protocols exactly there is not enough time to wash hands and provide care during a difficult case. At any rate, I have stopped shaking hands with patients for the most part.

Steve

Steve or Ralph?

Maybe there just has to be better facilities for washing hands?

Many restaurants have to spend money to ensure that plenty of hand washing stations are available so that meeting hand washing requirements doesn't interfere too much with the production process.

Not surprising. Lower on the totem scale, working as a CNA we were told to wash hands constantly.

Workers would bathe a patient and then not wash their arms when going to work in another room.

There has to be a step above a simple checklist for it to work.

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