Letters

Hand washing

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7208.518 (Published 21 August 1999) Cite this as: BMJ 1999;319:518

Why I don't wash my hands between each patient contact

  1. Andrew Weeks, specialist registrar in obstetrics and gynaecology (aweeks@surfaid.org)
  1. Scunthorpe General Hospital, Scunthorpe DN15 7BH
  2. Department of Microbiology, Salford Royal Hospitals NHS Trust, Hope Hospital, Salford M6 8HD
  3. St James's University Hospital, Leeds LS9 7TF
  4. Taunton and Somerset NHS Trust, Taunton TA1 5DA
  5. Royal Hospitals NHS Trust, London EC1A 7BE
  6. Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH
  7. Leeds General Infirmary, Leeds LS1 3EX
  8. Royal Infirmary of Edinburgh, Edinburgh EH3 9YW
  9. Chelsea and Westminster Hospital, London SW10 9NH
  10. Muslim Health Concern, London N4 2DA

    EDITOR—The editorial on hand washing calls for all hospital staff to start regularly washing their hands between each patient contact.1 If, as the authors claim, there is such compelling evidence for the need to wash hands between each patient contact then why do I and the vast majority of my colleagues not do it?

    Firstly, I have never seen any convincing evidence that hand washing between each patient contact reduces infection rates. The Handwashing Liaison Group assumes that we all know that hand washing is beneficial and therefore fails to put forward any evidence for it. It seems self evident that hand washing should be beneficial before and after a person has performed any procedures, examined wounds, or dealt with specifically high risk patients, but I have never seen any evidence for it in other situations. I shake hands with patients when I see them in hospital. Should I not do this, or should I wash my hands before and after each contact? Should patients be discouraged from social contacts with each other? Where is the evidence?

    Secondly, I have maybe 60 “touch” contacts with patients each day, and many more with relatives. Washing hands between each contact (at 1-2 minutes per wash) would take on average 1-2 hours. Where will this time come from, and who will fund it?

    If hand washing is to be performed between every patient contact then it would have major resource implications. For this it needs to be shown to be effective and worth the 15% extra staffing that would be needed to cover the extra time.

    References

    1. 1.

    Healthcare workers washed their hands on only a third of occasions

    1. Rachel Sen, microbiologist,
    2. Maeve Keaney, consultant microbiologist,
    3. Ann Trail, infection control nurse,
    4. Carol Howard, infection control support nurse,
    5. Paul Chadwick, consultant microbiologist (pchadwick@gen.srht.nwest.nhs.uk)
    1. Scunthorpe General Hospital, Scunthorpe DN15 7BH
    2. Department of Microbiology, Salford Royal Hospitals NHS Trust, Hope Hospital, Salford M6 8HD
    3. St James's University Hospital, Leeds LS9 7TF
    4. Taunton and Somerset NHS Trust, Taunton TA1 5DA
    5. Royal Hospitals NHS Trust, London EC1A 7BE
    6. Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH
    7. Leeds General Infirmary, Leeds LS1 3EX
    8. Royal Infirmary of Edinburgh, Edinburgh EH3 9YW
    9. Chelsea and Westminster Hospital, London SW10 9NH
    10. Muslim Health Concern, London N4 2DA

      EDITOR—We agree with the Handwashing Liaison Group that an explicit standard for hand washing needs to be set and that hand washing should be regarded as part of the normal duty of care.1 The group …

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