Repeat After Me: “Did You Wash Your Hands?”

April 24th, 2012

Health writers are very savvy when it comes to medical procedures. They talk with doctors, nurses, and medical researchers daily, and they read medical journals the way the rest of us read Sports Illustrated or People magazines. That’s what makes the opinion piece in the latest issue of The Journal of the American Medical Association (JAMA) so enlightening…and frightening.

The article—which talks about the need for hospital workers to clean their hands to prevent bacterial infections—was written by Suzanne C. Gordon, coeditor of the Culture and Politics of Healthcare Work series at Cornell University Press, and coeditor of the book First Do Less Harm: Confronting Inconvenient Problems in Patient Safety. Many infections can be spread from patient to patient when doctors and nurses don’t wash their hands before examining someone. Many hospitals have instigated hand-washing compliance programs, most have disinfectant dispensers in each room and/or in hallways, and some have even installed video cameras to make sure hospital staff know that they are being watched. There is even a program that suggests that patients watch to see whether doctors and nurses wash their hands, and if not, to request that they do so.

We’ve heard the advice about asking medical staff to please wash their hands; it is nothing new. What makes this story so compelling is that Ms. Gordon highlights exactly how difficult following this simple advice can be for patients. She tells the story of her own hospital stay after an emergency appendectomy.

“…[the nurse] grabbed the pair of dirty slipper/socks I’d been wearing, crumpled them up, and threw them in the garbage can. Then, without using the cleansing gel dispenser hanging on the wall in my room, or the soap and water in the bathroom, she went over to my IV and began fiddling with it.”

Ms. Gordon admits to being intimidated about asking the nurse to wash her hand because, as she noted: “This woman had the power to hurt me and I was afraid to anger her.” After raising the issue with another nurse (and begging her not to say anything to the first nurse):

“…the nurse who had not cleaned her hands entered my room. She stood in the doorway, arms folded across her chest, and glared at me. In what I, in my sick state, perceived to be a very aggressive tone, she declared, “I want you to know that I am very well aware of the need to take universal precautions and that I have my hands in hot water so much that they crack and hurt.” Then she turned and left the room.”

She requested that the offending nurse not be assigned to her, and the hospital obliged. If not, there could indeed have been repercussions if the nurse took offense, was angry, and was prone to revenge.

Even doctors who become patients can have a difficult time telling other doctors to wash their hands, even when they know it is in their best interests to do so, and even when there are signs in the room saying “Ask me if I cleaned my hands.” As one physician said of his experience when his wife was hospitalized:

“’I’m a pretty senior physician and a patient safety officer,’ he recalled. ‘This is my business and I hesitated. I finally did ask the resident and he said he had used the gel but would be glad to use it again. He was perfectly pleasant about it. But that has not always been my experience as a patient or family member. Sometimes people are agreeable. Sometimes they seem to resent the question. It’s really ludicrous to suggest that this should be up to patients,’ [the doctor] concluded.”

I think we can all agree on that point. Why is it up to patients to make sure that hospitals follow this simple and common safety procedure?

Ms. Gordon suggests two ideas about how health care personnel can help patients (and each other). First, to make sure that patients know that reminding staff about washing their hands is part of the patient’s “job,” that by doing so they can keep themselves and others safer. (There are many people who would gather the courage to ask about hand washing if they thought it would help the patient in the next bed, even while they might not speak up for themselves.)

Second, hospitals could create a “magic word” that would immediately trigger hand washing, without having to worry about how to phrase the request. It would make it easier for anyone to ask, even patients. As Ms. Gordon says in the article:

“But the only way this will work is if hospital and health care administrators make it crystal clear that they will back up anyone who challenges a person senior to themselves to enforce hand hygiene and that expressing such concern is not only an acceptable but expected action.

My suggestion for the magic word? It is simply ‘Hands!'”

So simple. Even a very sick person being treated in a hospital could remember that. And if doctors and nurses could learn what it means, then the world could be a healthier place. JAMA is one of the most respected, widely read medical journals in the world. With luck, hospitals will make this article required reading for all personnel. On behalf of patients, we would like to say “Thank you, Ms. Gordon!”

Article source: Gordon, SC. Ask Me If I Cleaned My Hands. JAMA. 2012;307(15):1591-1592.