Dirty Doctors

So, the media today is all over the evidence from the Dr Death inquiry that Dr Patel had very poor hand washing habits while he was at Bundaberg.

All well and good, but does the general public realise what a scandal the hand washing habits of doctors has been for decades? It is pretty clear to even the casual reader of medical journals that, despite attempts to introduce easier ways of getting doctors to clean their hands, compliance is still pathetic. Don't take my word for it, read this recent article from the Annals of Internal Medicine.

Look at the table on page 4: compliance amongst surgeons was worse than most other doctors! 36%!! What is it about surgeons that makes them so careless about this? A superiority complex? Just too busy to prevent cross infection?

An easier to read commentary on this study is the editorial from the same journal linked here: editorial A couple of quotes:

"How are we doing? It is too early to tell in the United States, where hand hygiene rates average 40% to 60% on a good day. However, European hospitals have been using alcohol-based rubs for many years, so it seems reasonable to look to Europe for evidence of success of the alcohol hand-rub strategy.....[in Europe] the good news is an increase in hand hygiene rates when physicians were aware of being observed; therefore, we can say that we respond to peer pressure, at least when evaluated as a group. The bad news is that the rates were only 61% when physicians thought someone was watching; when physicians did not think anyone was watching, rates averaged 44%.

In conclusion, after more than 150 years of prodding, cajoling, educating, observing, and surveying physicians, hand hygiene adherence rates remain disgracefully low."

Australian doctors are no different (see 1996 study here.) Which would indicate that at any given time there is about a 50/50 chance that your hospital doctor has not washed his or her hands before seeing you from his last patient. If a surgeon, the risk seems likely to be higher.

This is very, very bad.