Intended for healthcare professionals

Rapid response to:


Hand washing

BMJ 1999; 318 doi: (Published 13 March 1999) Cite this as: BMJ 1999;318:686

Rapid Response:

Also general practitioners can improve their hand washing habits.

The Handwashing Liaison Group states that the hand washing habits of
the hospital staff can be improved(1). This statement can be extrapolated
to the healthcare workers of the primary care, as you can see from
following results.

From January to March 1999 a select sample of Flemish
general practitioners was interviewed by telephone(response:200/230). They
were asked if they washed their hands after their last patient contact.

Sixty three percent of the GPs (n=126) washed their hands after their last
consultation, but only 21 % (n=43) did so after their last home visit,
although they were confronted respectively with 22% and 43% infectious
diseases during consultation and home visit. From those who did wash their
hands after consultation, 63% did so by using water and soap. Only 17%
used a towel for single use.
The table shows the reasons for not washing hands:


  Reasons                 Consultation       Home visit
                           n=74                n=157      
-too complicated           0%                49%
to ask their patients
-hand washing in the car   0%                10%
or at home
-no infectious contact    46%                16%
-no habit                 15%                10%
-lack of time             12%                 6%
-forgotten                14%                 3%
-afraid of irritation      5%                 0%
of the hands 
-no idea or no answer      8%                 6%	

Age and gender had no statistical influence on the frequency of hand
washing. Only the GPs who were working in group washed their hands lesser
than those working single-handed (consultation: p=0.0006; home visit:

These results show that especially on home visit general practitioners
have difficulties in organising hand washing even knowing they are dealing
with an infectious disease. Some older patients still have the tradition
to offer their family doctor a basin with soap and a clean towel, but this
is a disappearing custom. Also the single-handed working GP is more old
fashioned and more accustomed to include hand washing during his daily
routine. The time-loss is relative: during hand washing you can continue
your conversation with the patient!

GPs must be more aware of their role in transmitting infections from one
patient to the other and must train themselves to make hand washing a
routine action. Early practical exercising by students during their
medical education is essential to learn a good hand washing behaviour(2).

During home visits patients can help by reminding or by offering their GP
the occasion for hand washing after the clinical examination(3). The use
of alcohol gel can be a good alternative to decontaminate the hands after
a home visit(4). It is effective (if the hands are not dirty), quick and
easy to use. Irritation of the skin or dermatitis can be prevented by
using hydrating soap formulas, hand cream or gloves(5).

Authors: Michiels Barbara, Avonts Dirk, Van Royen Paul, Denekens Joke

1. Handwashing Liaison Group. Hand washing. BMJ 1999;318:686.

2. Aspöck C, Koller W. A simple hand hygiene exercise. Am J Infect Control

3. Sen R, Keaney M, Trail A, Howard C, Chadwick P. Healthcare workers
washed their hands on only a third of occasions. BMJ 1999;319:518.

4. Richard C, Welbourn B, Jones SM. Alcohol hand rubs are better than soap
and water. BMJ 1999;319:518.

5. Paulson DS., Fendler EJ., Dolan MJ., Williams RA.. A close look at
alcohol gel as an antimicrobial sanitizing agent. Am J Infect Control

Competing interests: ____________________________________________________________ Reasons Consultation Home visit n=74 n=157 ____________________________________________________________ -too complicated 0% 49%to ask their patients-hand washing in the car 0% 10%or at home-no infectious contact 46% 16%-no habit 15% 10%-lack of time 12% 6%-forgotten 14% 3%-afraid of irritation 5% 0%of the hands -no idea or no answer 8% 6% ____________________________________________________________

25 October 1999
Michiels Barbara
general practitioner- assistent