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1995 | 06 | 29 | Articles | The News & Observer | Health
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The News & Observer (Raleigh, NC)
June 29, 1995
Page E1
You have a hand in passing germs
By Stewart Ugelow
STAFF WRITER

Last week the nation’s doctors finally confessed: They haven’t been washing their hands often enough.

Medical insiders say the problem has existed for years, but the doctors’ admission at the American Medical Association convention in Chicago is still hard to believe.

Reminding doctors to wash their hands should be like reminding lawyers to bill their clients. A no-brainer. If they can’t master basic hand washing, then they probably didn’t get much else out of medical school.

After all, experts from the Centers for Disease Control and Prevention to the Mayo Clinic call hand washing the single most important way to stop infectious diseases from spreading.

But the "Ten Dirty Digits" resolution the AMA adopted June 22 says doctors simply aren’t washing their hands between patients. There’s only a 14 to 59 percent hand washing rate among doctors and a 25 to 45 percent rate among nurses. The resolution suggests the problem is so serious that cameras should be installed in hospital wards to check.

Doctors are not just derelict in their hand washing at hospitals. During a 1993 convention of the Infectious Diseases Society of America - doctors and other specialists who study germs and the transmission of disease - medical students staked out restrooms to see whether those who knew all the reasons to wash their hands actually did. Of the 493 experts they counted, only 56 percent of men, and 87 percent of women, washed up before walking out.

"This isn’t a new problem," said Theresa Klimko, an infectious disease epidemiologist with the state Department of Environment, Health and Natural Resources. "These kinds of studies have been going on for several years."

One hundred forty eight years, to be exact. In 1847, Dr. Ignaz Semmelweiss reported that doctors who washed their hands spread fewer germs. His colleagues responded by declaring Semmelweiss insane and committing him to an asylum for the remainder of his life.

The current hand-wringing over hand-washing comes on the heels of a 1994 study suggesting that as many as 1 in 20 hospital patients is infected by doctors or nurses who fail to wash their hands.

Doctors also say that rubber gloves are no substitute for a good scrub.

"As gloves are used, especially around teeth and body cavities, it’s hard on the thin latex, and tiny holes can develop," said Dr. James Crawford, a microbiologist and infection control coordinator for the University of North Carolina at Chapel Hill School of Dentistry.

Before gloves, dentists had to wash up to 60 times a day, he said. And those weren’t flick-on-the-faucet-and-twirl-your-hands-around-for-a-few-seconds washes. Those were 60 thorough washes.

"A thorough wash, if you lather and rinse twice, takes about 15 seconds to accomplish what you’re going to accomplish," Crawford explained. "To do anything more, you would need to wash for 30 seconds to a minute."

At 15 seconds per wash, that works out to 65 hours of hand washing per year.

Doctors aren’t the only ones who aren’t scrubbing up when they should.

As the head of the state Department of Environmental Health’s Food, Lodging and Institutional Sanitation branch, Susan Grayson makes her living making sure that food professionals, day care workers and others required by law to wash their hands actually do.

"I’m one of those strange people who goes into ladies rooms to watch if people wash their hands," she said. "From personal observation, I can tell you only 50 percent of women wash their hands."

While many of the people required by law to wash their hands fall under Grayson’s jurisdiction, others are forced to wash by higher authorities.

In Judaism, for instance, observant Jews must ritually wash their hands upon waking up, leaving a bathroom, before praying, before eating meals and sometimes even before preparing them, says Rabbi Pinchas Herman of Raleigh’s Congregation Sha’Arei Israel-Lubavitch. "Our custom is to pour water three times on the left hand and three times on the right hand," Herman explained. "Some do it twice, some do it once. There are different customs."

So how frequently does the rabbi wash his hands?

"Well, it depends on how often I go to the bathroom," Herman said, laughing. He says he probably washes 10 times a day.

And, he says, because ritual hand washing is done for spiritual and not hygienic reasons, hands must be clean before they’re washed. Which means washing twice.

Then there are the people who have to wash their hands not because of any law but because they simply can’t stop.

People suffering from obsessive-compulsive disorder often have an abnormal fear of contamination that leads to constant hand washing, says clinical psychologist Dr. Mark Lefebvre, who sees two to three patients per week for compulsive hand washing.

"It’s common that people are afraid of contamination not because it would hurt them but because they might inadvertently hurt someone else," he said. "They hit upon hand washing as a way of alleviating that anxiety of contamination. A vicious cycle is set up."

The disorder can be treated with medications such as Prozac and behavior modification therapy. Treatment usually takes 10 sessions, Lefebvre said.

Unfortunately, the treatment might not work in reverse. Which means those who suffer from lapses in their hand washing hygiene will just have to remember to wash on their own. Or maybe they could take the AMA’s advice and do what the doctors ordered.

Then we could all wash our hands of this matter.

###

Hands act as carriers for germs, which flourish thanks to their warmth, moisture and oils. While you generally can’t get sick simply from having germs on your hands, you can whenever you touch those hands to your mouth, eyes or nose.

"Hate your boss?" asks Susan Grayson, head of the state Department of Environmental Health’s Food, Lodging and Institutional Sanitation branch. "Get a bad cold, cough in your hand and shake his. You can pass lots of germs along like that."

Experts recommend that you wash your hands for at least 20 to 30 seconds whenever you come into contact with something that could have been contaminated by germs, human or animal feces, urine and hazardous materials.

"The most important thing is to do a thorough job," Grayson says. "Be sure to get in between the fingers, around the cuticles and under your nails. And don’t forget your wrists."

You should wash your hands whenever you do the following:

Prepare food.

Clean bathrooms or mop the floor.

Feed your pets or clean their cages.

Blow your nose.

Change a diaper.

Touch lead paint.

Use a public restroom (Remember that faucet handles in the restrooms can get germs on them, too. And if others don’t wash their hands, everything from doorknobs to bowls of mints may be contaminated.).