Docs Wash Hands Like Guys In Gas Station Bathroom

Thursday was Global Handwashing Day

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.

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  1. A gas station, fueling station, filling station, service station, petrol station, garage, gasbar, petrol pump or petrol bunk (India) is a facility which sells fuel and lubricants for motor vehicles. The most common fuels sold are petrol (gasoline in U.S. and Canada) or diesel fuel.
    Fuel dispensers are used to pump petrol (gasoline in U.S. and Canada), diesel, CNG, CGH2, HCNG, LPG, LH2, ethanol fuel, biofuels like biodiesel, kerosene, or other types of fuel into vehicles. Fuel dispensers are also known as bowsers (in Australia), petrol pumps (in Commonwealth countries), or gas pumps (in North America).
    In recent times, filling stations have also begun to sell butane and have added shops to their primary business; convenience stores are now a familiar sight alongside pumps. With the advent of electric vehicles and rechargeable battery operated cars, “gas stations” or “filling stations” will soon offer charging docks for these cars. In fact, certain stations in the United States and other countries already offer these services. The term “gas station” is mostly used in the United States and Canada, where the fuel is known as “gasoline” or “gas”. In some regions of Canada, the term “gas bar” is also frequently used. Elsewhere in the English-speaking world, where the fuel is known as petroleum, the form “petrol station” or “petrol pump” is used. In the United Kingdom and South Africa the single noun garage is still commonly used, even though the petrol station may have no service/maintenance facilities which would justify this description. Similarly, in Australia, the term service station (“servo”) describes any petrol station. In Japanese English, it is called a “gasoline stand”. In Indian English, it’s called a petrol pump or a petrol bunk. In some regions of America and Australia, filling stations often have a mechanic on duty, but this is uncommon in other parts of the world.

  2. I’ve seen in many locations the signs that say you have the right to ask those in healthcare jobs if they’ve washed their hands….but even with that sign, are you really going to ask that question? Half the people are afraid to say anything even slightly negative to nurses and doctors (which is a shame that this relationship exists), no less nearly accuse them of not washing their hands. Seems like you just have to hope for the best.

  3. If we really have to discuss bathroom hand hygiene here, let me add that the urine of a healthy person is sterile. But that has little to do with hospital handwashing and desinfectant use, which is a real problem. I think that this will only get better with a combination of repetitive education, incentives and peer pressure, over years, similar to what happened with smoking (and should happen with the sedentary lifestyle and overeating).

  4. I’m sure all of these doctors are naturally very clean and the real problem is patients and administrators introducing bacteria etc. into their environment. Where is the discussion about patients and administrators washing their hands! Why put this all on the doctors?

  5. This sounds more like a Seinfeld episoide than good science?
    This obession with handwashing is beyong the pale anyway.
    Because no matter how hard we wash, like Shakespeare’s Lady Macbeth, the stains of the sins of what we have done to US Health care will not go away.
    Dr. Rick Lippin