OK, a new study by the London School of Hygiene & Tropical Medicine did not directly compare how often someone washes their hands after using a gas station bathroom and how often your doctor washes his hands before examining you. But, being careful not to touch anything, we can do the math.
The School of Hygiene study just published in the American Journal of Public Health, placed electronic sensors in service station bathrooms along highways in Britain to see the way men and women responded to electronic reminders to wash their hands with soap and water. After monitoring some quarter of a million people, they found that 32 percent of men and 64 percent of women washed their hands.
Most of the electronic messages caused some improvement in hand-washing, but the one that worked best was, “Is the person next to you washing with soap?” As one researcher told the BBC, “What other people think – what is deemed to be acceptable behavior – is probably a key determinant….It was interesting to see that, for men, the more people there were in the toilet, the more likely they were to wash their hands with soap.”
Which makes the average British male very much like U.S. doctors. As an article by Didet et al. in the Annals of Internal Medicine (and concluded, doctor hand-washing “was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution.”
But at least British motorists aren’t stepping out of the gas station into a surgical gown. A multicenter study in the United States, published earlier this year by McGuckin and colleagues in the American Journal of Medical Quality, found that baseline compliance for following hand hygiene rules was just 26 percent in intensive care units and 36 percent in non-ICUs. After a 12-month “feedback intervention,” compliance increased to just 37 percent for ICUs – about the level of the average guy using a bathroom in a British gas station – and 51 percent for non-ICUs – still below the average female British bathroom user. (No word on whether female doctors washed their hands more than their male counterparts.)
The School of Hygiene study said that men responded best to messages of disgust, such as, “Soap it off or eat it later.” Meanwhile, the World Health Organization estimates that health care-associated infections affect as many as 1.7 million patients in the United States each year, cost $6.5 billion and contribute to more than 90,000 deaths annually.
Perhaps sinks in U.S. hospitals should consider electronic messages of their own, such as, “Soap me before I kill again.”
Michael L. Millenson is the president of Health Quality Advisors LLC and holds an adjunct appointment at Northwestern University’s Kellogg School of Management. He is the author of Demanding Medical Excellence: Doctors and Accountability in the Information Age and, earlier in his career, was a Pulitzer Prize-nominated reporter for the Chicago Tribune.