Hand washing

British Medical Journal, August 21, 1999

Frustrated by our attempts to improve compliance with hand washing and to make staff appreciate its importance, we performed an observational study of the handwashing behaviour of 200 healthcare staff in a personal setting. Members of the infection control team unobtrusively observed 100 female and 100 male healthcare workers (predominantly nurses, doctors, caterers, and nursing and medical students) using the toilets in the medical education centre; they counted the number who washed their hands after using the toilets. To compare their handwashing rates with those of members of the public, the same study was performed in public toilets in a railway station. We found that 59 of the male healthcare workers and 83 of the female healthcare workers washed their hands after using the toilet, compared with 34 of 100 male members of the public and 56 of 100 female members of the public.

The apparent difference in handwashing rates between men and women may account for the differences in handwashing behaviour that some observers have reported to( nurses and doctors, among whom one or other sex predominates.[2] If these results are representative of our community as a whole then improving handwashing rates on the wards will continue to challenge us.

Everyone needs to appreciate the importance of washing their hands. In addition to the recommendations made by the Hand Washing Liaison Group, we recommend that basic hygiene should be taught in schools as part of the curriculum; public health information campaigns in the media should direct the public's attention to the potentially lifesaving practice of washing one's hands.

Paul M Hateley lead nurse, infection control Royal Hospitals NHS Trust, London EC1A 7BE

P A Jurnaa locum consultant microbiologist Great Ormond Street Hospital for Children NHS Trust, London WC 1N 3JH

[1] Handwashing Liaison Group. Hand washing. BMJ 1999;318:686. (13 March.)

[2] Dorsey ST, Cydulka RK, Emerman CL. Is hand washing teachable? Failure to improve hand washing behaviour in an urban emergency department. Acad Emerg Med 1996;3:360-5.

Dermatitis associated with frequent hand washing should have been mentioned

EDITOR--I do not disagree with anything in the editorial about hand washing, but it should have acknowledged the problem of dermatitis associated with frequent hand washing.[1 2] This condition causes considerable discomfort to a large proportion of healthcare workers, most of whom suffer in silence. A definition of what constitutes a patient contact requiring hand washing would have been helpful. I regularly have contact with over 50 patients in a day and dread to think how red, dry, and cracked my hands would be if I washed after every contact. In a recent survey of intensive care staff the prevalence of occupational hand dermatitis was 55.6%, rising to 69.7% in those washing more than 35 times per shift.[3]

No mention was made in the editorial of the appropriate solutions with which to wash. Certain solutions are kind to hands, while others are notorious for producing dermatitis.[2] The newly introduced handwashing solution in wards in my hospital is harsh to hands, and anecdotal reports suggest that nurses may be avoiding washing their hands because of this. The free provision of hand moisturisers could be of value in preventing dermatitis.