Don't wash your hands of this civic duty

You can lead a man to hot water, but you can't make him wash his hands.

That's the reality health experts face as they strive to convince the nation of the importance of regular, thorough hand washing to preventing the spread of H1N1 flu and other illnesses.

The latest evidence of that challenge came earlier this month when the Joint Commission, which evaluates and accredits health care organizations in the United States, released a report showing that employees last spring at eight hospitals around the country did a mediocre job of cleaning their hands.

While the hospital workers' dedication to hand hygiene improved with training, the report leads to a question — if many hospital workers don't practice excellent hand hygiene, how are schoolchildren, restaurant workers and mall shoppers performing?

“Probably not very well,” said Cindy Brison, a University of Nebraska-Lincoln Extension educator and food safety expert. Brison said studies have shown that only somewhat more than half of people who go to the restroom wash their hands immediately afterward.

A spot check at two malls and one downtown restaurant on a recent night found that six of 10 men washed their hands after going to the restroom.

At least one of those six had his hands under water for only two seconds. That's nowhere near the recommended length to wash, which experts sometimes describe as the time it would take to sing the happy birthday song twice.

Dan Wallace, a 28-year-old Omahan who recently walked his two corgi dogs on a sunny evening at Zorinsky Lake, said the H1N1 scare hasn't compelled him to be more diligent.

“I work in a kitchen, so I wash my hands a lot at work,” said Wallace, a cook. “But at home, (I wash them) whenever I go to the bathroom, whenever they're dirty.”

Wallace said he doesn't necessarily wash his hands immediately after petting his corgis, but he does wash them before preparing food at home.

Health experts say the times for hand washing are plentiful — after sneezing or blowing your nose, after going to the restroom, and before and after handling food or eating. Some said they'd wash their hands after petting a dog or cat.

Cathy Jesus, director of clinical quality improvement at the Creighton University Medical Center, said the time to hammer home the importance of hand washing is around first grade.

“I have three boys, and I'm constantly telling them ‘Did you wash your hands? Get back in there and wash your hands.'”

Sharon Wade, supervisor of health services at Omaha Public Schools, said she believes elementary school children are doing a good job of washing their hands after going to the restroom. Teachers monitor them and remind them to do so.

“You have a lot more control with them,” Wade said.

She said that in meetings with principals, she stressed the need to stay after older students, who are less malleable. “They kind of have their own agenda,” Wade said.

At three Culvers restaurants in the Omaha area, owner Dave Weist said he began to put dispensers with sanitary gel next to cash registers about four weeks ago. They are there for customers as well as employees.

“You just hope that everybody takes those things seriously,” Weist said.

Dr. Mark Chassin, president of the Joint Commission, said hospital workers have a greater need to maintain clean hands. They are dealing with the sickest in society, people who may not withstand another blow to the body, such as an infection.

Nevertheless, with the regular flu season having arrived as well as the new H1N1 strain, “we're all going to have to get a lot better at hand washing,” Chassin said.

The Joint Commission's new Center for Transforming Healthcare took on hand washing as its first initiative because infections caused by medical care kill nearly 100,000 Americans a year, the commission wrote.

Employees in eight hospitals, including one in Colorado and one in Wisconsin, were trained to observe their colleagues going into patient rooms and coming out. Each of those moments is supposed to be accompanied by a hand washing or use of sanitary gel.

The observers found that nurses, doctors, food- and linen-service workers and others washed their hands less than 50 percent of the time. The testing was done last spring.

Steps were taken to improve hand hygiene. They included providing easier access to dispensers and sinks; creating spots where people with items in their hands could set them down to wash hands; and coaching with the understanding that linen-service workers, for instance, typically don't know as much about infection control as nurses.

Compliance at the hospitals had increased to close to 80 percent as of late summer.

Alegent Health, Creighton University Medical Center and Nebraska Medical Center all use observers, some of them staffers and some “secret shoppers” from the outside, to collect data on staff hand washing.

Administrators at each hospital said they also encourage patients — in admissions discussions, flyers, handbooks or other ways — to ask caregivers if they have washed their hands before entering the room.

At the Nebraska Medical Center, if an employee is chronically negligent, he can be reported to Dr. Mark Rupp for a talking to. Rupp is the medical center's infectious disease specialist.

“And that has happened,” Rupp said.

Although disciplinary measures could be used, discussions have had the desired effect, he said.

At Alegent, staff members who see a colleague fail to wash his hands are encouraged to say: “What color is the soap today?” said Dr. Mark Kestner, Alegent's chief medical officer. That minimizes the confrontation of bluntly correcting a colleague.

Ultimately, “we have to create a culture where it's socially acceptable” for patients and colleagues to insist on sound hand hygiene and care, he said.

Contact the writer:

444-1123, rick.ruggles@owh.com