Hand Washing Isn’t Just for Kids

Would you want to eat at a restau­rant where kitchen staff and servers did­n’t wash their hands, or where lack of basic hygiene risked mak­ing you sick?  If it came to light that this was a con­tin­u­ing prob­lem, that restau­rant would soon be out of busi­ness. You’d nev­er tol­er­ate the excuse “We’re only human.”

But that’s exact­ly what’s hap­pen­ing in thou­sands of hos­pi­tals in the U.S. and Cana­da, where lack of com­pli­ance with required safe­ty pro­to­cols is mak­ing patients sick­er.

Each year, one mil­lion patients in the U.S. and Cana­da will get an infec­tion, such as Clostrid­i­um dif­fi­cile (C. dif­fi­cile) or ventilator-associated pneu­mo­nia, while they’re in the hos­pi­tal.  At least eighty-five thou­sand will die.  Every year.  

Hospital-acquired infec­tions nev­er send a call­ing card before they show up in a patient’s room. But patients and fam­i­lies will always know after they’ve arrived.

Hand hygiene is rec­og­nized as one of the most effec­tive strate­gies for reduc­ing hospital-acquired infec­tions.  For decades, patient safe­ty advo­cates have been wag­ing a cam­paign to get health­care work­ers to wash their hands.   Mil­lions of dol­lars have been spent on con­fer­ences, videos, research papers, but­tons and posters.

Still, in many hos­pi­tals vol­un­tary com­pli­ance falls far short of where it needs to be, even when it is self-reported with­out any inde­pen­dent ver­i­fi­ca­tion.  At Toron­to’s famed St. Michael’s Hos­pi­tal, for instance, admin­is­tra­tors report that hand wash­ing before patient con­tact hap­pens only 55.5 per­cent of the time.   And that’s at a major surgery cen­tre.

There are tech­nolo­gies avail­able that can scan when a health­care work­er san­i­tizes his or her hands before and after patient con­tact.  Some hos­pi­tals use cam­eras to mon­i­tor and report hand wash­ing com­pli­ance.  But too many leave it to chance.  The time has come to get beyond plead­ing and pros­e­ly­tiz­ing.

Zero tol­er­ance for not com­ply­ing should be the norm.  Hos­pi­tals that don’t live up to the high­est stan­dards of com­pli­ance — stan­dards that need to be sub­ject to peri­od­ic inde­pen­dent human and elec­tron­ic audits —  should face finan­cial penal­ties.




  1. Hand Hygiene Basics

    Excerpt from the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC)

    In the Unit­ed States, hos­pi­tal patients get an esti­mat­ed 722,000 infec­tions each year. That’s about 1 infec­tion for every 25 patients. Infec­tions that patients get in the hos­pi­tal can be life-threatening and hard to treat. Hand hygiene is one of the most impor­tant ways to pre­vent the spread of infec­tions.

    Health­care providers should prac­tice hand hygiene at key points in time to dis­rupt the trans­mis­sion of microor­gan­isms to patients includ­ing: before patient con­tact; after con­tact with blood, body flu­ids, or con­t­a­m­i­nat­ed sur­faces (even if gloves are worn); before inva­sive pro­ce­dures; and after remov­ing gloves (wear­ing gloves is not enough to pre­vent the trans­mis­sion of pathogens in health­care set­tings). For a full list of hand hygiene indi­ca­tions, please see the rec­om­men­da­tions in the Hand Hygiene Guide­line Adobe PDF file.

    Patients and their loved ones can play a role in help­ing to pre­vent infec­tions by prac­tic­ing hand hygiene them­selves as well as ask­ing or remind­ing their health­care providers to per­form hand hygiene.


A few years ago, Long Island’s North Shore Uni­ver­si­ty Hos­pi­tal had a dis­mal com­pli­ance rate with hand washing—under 10%. After installing cam­eras at hand-washing sta­tions, com­pli­ance rose to over 90% and stayed there.

–From an Arti­cle in the Wall Street Jour­nal by Dr. Mar­ty Makary


Hospital-acquired infec­tions nev­er send a call­ing card before they show up in a patient’s room. But patients and fam­i­lies will always know after they’ve arrived.