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:

Can British medical students pass their final examinations without washing their hands?

As the Handwashing Liaison Group point out most doctors do not wash
their hands often enough 1. We decided to investigate how easy it is for
British medical students to pass their final examinations without washing
their hands.

In late August 1999, one of us (MT) telephoned the teaching hospital
most closely associated with each of the 24 British Medical Schools and
questioned, in turn, the duty preregistration house physician and house

MT asked when and where each doctor had qualified and then asked:

“Did you wash your hands in between examining most patients in the
short case section of your final examinations?”

We wrote to the Deans of the 24 British medical schools and asked
which of the following two statements best described the position of their
medical school in relation to hand washing in the short case section of
the final examination:

* The students are expected to wash their hands between each patient

* This is left to the discretion of individual examiners.

We interviewed forty-five of the 48 doctors (94%) in our sample.
There was at least one respondent from 22 of the 24 British medical
schools. All but one doctor had qualified in 1999.

Only three of the 45 respondents (7%; 95% confidence interval 1, 18)
reported that they washed their hands between examining “most patients”
during the short case section in their final examinations.

Fifteen of 24 Deans (63%) responded to our questionnaire. Only four
of the 15 (27%) reported that students were “expected to wash their hands
between each patient”.

It is disturbing that almost all our sample of recent British medical
graduates were able to qualify as doctors without washing their hands in
between examining “most patients”. These findings, combined with the
results of our survey of undergraduate Deans, show that few British
medical schools have a strict policy about hand washing in final
examinations. Our findings are a manifestation of the widespread apathy
that many doctors feel about routine handwashing.

Our survey is small but included graduates from all but two of the
medical schools in the United Kingdom. We did not observe behaviour
directly but we see no reason why those surveyed should have
underestimated how often they washed their hands. All but one interview
was within three months of the doctor’s final examinations.

The microbiological risks in examinations are probably low. However,
there are two further reasons for hand washing: as an act of courtesy and
to ensure that hand washing becomes automatic (and is not forgotten when
it is microbiologically important). The Handwashing Liaison Group has
called for an explicit standard whereby “hands should be decontaminated
before each patient contact.” 1

For this simple standard to have any chance of being adopted medical
schools need to insist that students wash their hands in between examining
patients. Surely it should not be possible for medical students to pass
their final examinations without washing their hands in between examining

Hand washing
Hand washing liaison group
BMJ 1999;318:686

No competing interests

Competing interests: No competing interests

23 December 1999
M Thorpe
Locum paediatric registrar, paediatric consultant
B W Lloyd
Royal Free Hampstead NHS Trust