FRIDAY, July 9, 2004 (HealthDayNews) -- Many doctors fail to wash their hands when they should, and the worst offenders are those who work in operating rooms or emergency departments.

So finds a small study involving 163 medical students, residents and staff physicians at the University of Geneva Hospital in Switzerland.

Anesthesiologists were the least compliant, washing up only 23 percent of the times they should have. Surgeons, ranking second from the bottom, had only a 36 percent compliance record of practicing proper hand hygiene. Doctors in emergency medicine complied only 50 percent of the time, according to the report, which is published in this week's issue of the Annals of Internal Medicine.

"They are extremely busy and therefore it is difficult to comply," explained study author Dr. Didier Pittet, director of the Infection Control Program at University of Geneva Hospitals.

Overall, doctors practiced proper hand hygiene only 57 percent of the time when opportunities for hand washing arose, the study found.

Doctors in internal medicine, by contrast, had an 87 percent compliance rate -- the best of all of the medical specialties.

Despite efforts to encourage doctors to use good hand-hygiene practices, compliance remains universally low, experts said.

In the United States, "hand hygiene rates average 40 percent to 60 percent on a good day," Dr. Robert A. Weinstein, chairman of the Division of Infectious Diseases at Chicago's Stroger (Cook County) Hospital, noted in an accompanying editorial in the journal.

However, there's more at stake than personal grooming habits. Poor hand hygiene poses a real risk to patients, said Dr. Paul Schyve, vice president of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). It puts individual patients at risk of hospital-acquired infections and could lead to the spread of drug-resistant bacteria throughout a hospital.

In 2002, the U.S. Centers for Disease Control and Prevention issued revised national recommendations that promote the use of alcohol-based hand rubs to decontaminate hands if they are not visibly soiled. Infection control experts say the rubs are effective, and because they are easy to use they should remove any obstacle to hand washing.

At University of Geneva Hospital, individual bottles of alcohol-based liquid hand disinfectant are available in all areas, and doctors are encouraged to carry bottles of the solution with them.

Still, two thirds of the doctors in the study perceived hand hygiene as a difficult task, "which is a disappointing response to the recently revised guidelines," Weinstein noted.

To understand why doctors are lax about hand hygiene, Pittet and his colleagues deployed trained observers to count the number of times that doctors should have cleaned their hands and record the number of times they actually did. Afterward, the physicians were asked to complete a questionnaire on their attitudes and beliefs about hand washing.

Researchers found adherence was higher but still not great when doctors were aware they were being observed --61 percent compared to 44 percent.

The authors say the findings underscore the importance of role models in motivating physicians to adopt better hand-washing habits.

"If a senior physician adheres appropriately to the practices, the odds for a junior to adopt the same behavior are high," Pittet explained.

Unfortunately, the opposite is also true. Poor adherence to hand hygiene practices, he added, sets a bad example that quickly will be replicated among trainees and more junior doctors, even if students and junior staff had planned to comply.

Recognizing the importance of hand hygiene, the JCAHO in 2004 set a new patient safety goal for all of its accredited hospitals in the United States aimed at reducing heath care-acquired infections. To maintain accreditation, hospitals must demonstrate that they comply with the CDC's hand hygiene guidelines.

There will be lapses, acknowledged Schyve. The point is to make sure hospitals have systems in place to encourage hand hygiene.

"We want to see what the organization has done to try to facilitate this," he said.

Weinstein argued that hand hygiene -- including use of alcohol rubs -- needs to be ingrained in doctors.

"Reasoning with people doesn't work anymore," he said. "Cleaning your hands with this stuff has to be your religion."

More information

Visit the U.S. Centers for Disease Control and Prevention to learn more about hand hygiene.

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