Tuesday, August 24, 2010

Hand Hygiene Among Doctors Exposed



# 4831



There is an old joke that says that half of all people don’t wash their hands with soap and water after using the toilet.


Those people are called men.



While not completely true, men do have a reputation for being less than fastidious in such matters.  


But you’d think that doctors . . .  particularly infectious disease doctors . . . would all faithfully wash their hands vigorously with soap and water before leaving the restroom.


But if you did, of course, you’d be wrong.  


Today we’ve an observational study conducted at two scientific conferences on the hand washing habits of doctors. 


The first was the 26th Meeting of the Scandinavian Society on Antimicrobial Chemotherapy (SSAC) in Tromsø, Norway, and second took place at the International Congress on Antimicrobial Agents and Chemotherapy (ICAAC) in San Francisco, CA.


Both took place last September, during the pandemic.


Observers stationed in the men’s and women’s restrooms kept track of the hand washing compliance among the men and women (mostly infectious disease specialists) attending these conferences.


The results, while better than others we’ve seen among the general public, were still less than comforting.


The study appears in the latest edition of The AJIC (American Journal of Infection Control) and is called:


Do as I say, not as I do: Handwashing compliance of infectious diseases experts during influenza pandemic

Anu Kantele, MD, PhD, Mari Kanerva, MD, PhD, Mikko Seppänen, MD, PhD, Jussi Sutinen, MD, PhD, Kirsi Skogberg, MD, PhD, Laura Pakarinen, MD, Iiro H.S. Jääskeläinen, MD, Inko Aho, MD, Asko Järvinen, MD, PhD, Taru Finnilä, MD Jukka Ollgren, PhD



It is a relatively short article, with just one chart displaying the HWWS (Hand Washing With Soap) compliance among men and women at these two conferences.


The bottom line was that in San Francisco only 69% of the men were observed to wash with soap and water, and 86% of the women.


In fairness, I should mention that many of the non-compliant restroom visitors did rinse their hands with water before exiting. 


Feel better?  I thought not. 



Hand hygiene at the Tromsø, Norway conference was even less comforting, with just 38% of the men, and 84% of the women using soap and water.


Last year, in a blog titled Doing The Hand Jive I wrote about a market research study conducted in 2007 by HarrisInteractive that looked at hand washing habits in 6 public venues around the United States.


While nine in ten (92%) adults surveyed claimed they always washed their hands after using public restrooms; just over three in four (77%) were observed doing so (down from 83% in 2005).


Men were less likely to wash their hands than women, with only 66% stopping to wash, as opposed to 88% of women.


And since I’ve never missed an opportunity to beat a dead horse, I’ve one more study to share, this time from BMC Infectious Diseases, which pretty clearly demonstrates the efficacy of hand hygiene.


I’ve excerpted from the abstract (and have reformatted for readability), but follow the link to read the entire (open access) study.


Effectiveness of alcohol-based hand disinfectants in a public administration: Impact on health and work performance related to acute respiratory symptoms and diarrhoea


Nils-Olaf Hubner , Claudia Hubner , Michael Wodny , Gunter Kampf  and Axel Kramer


Our study involved a prospective, controlled, intervention-control group design to assess the epidemiological and economical impact of alcohol-based hand disinfectants use at work place. Volunteers in public administrations in the municipality of the city of Greifswald were randomized in two groups. Participants in the intervention group were provided with alcoholic hand disinfection, the control group was unchanged. Respiratory and gastrointestinal symptoms and days of work were recorded based on a monthly questionnaire over one year. On the whole, 1230 person months were evaluated.


Hand disinfection reduced the number of episodes of illness for the majority of the registered symptoms.

This effect became statistically significant for common cold (OR = 0.35 [0.17 - 0.71], p = 0.003), fever (OR = 0.38 [0.14-0.99], p = 0.035) and coughing (OR = 0.45 [0.22 - 0.91], p = 0.02).


Participants in the intervention group reported less days ill for most symptoms assessed, e.g. colds (2.07 vs. 2.78 %, p = 0.008), fever (0.25 vs. 0.31 %, p = 0.037) and cough (1.85 vs. 2.00 %, p = 0.024). For diarrhoea, the odds ratio for being absent became statistically significant too (0.11 (CI 0.01 - 0.93).