Doctor, Did You Wash Your Hands?® There is a sign in my primary care provider’s examination room:

Patients and Visitors



Germs that can cause serious infections are in every healthcare facility. They can be on your healthcare provider’s hands and also your own.

It’s OK to ask for clean hands. It could save your life. Make sure everyone around you has clean hands to protect against infection.



Hand hygiene plays a critical role in preventing the spread of pathogens that can lead to healthcare-associated infections (HAI), yet many U.S. health systems are falling short on their hand hygiene compliance rates. The Centers for Disease Control & Prevention (CDC) estimates that healthcare providers clean their hands about half the times they should. Missing these hand hygiene opportunities puts patients at risk for HAIs.” (K)

ASSIGNMENT: Develop an evidence-based hand-washing plan for your community hospital.

“Hand hygiene is described by many health care workers as the single most important tool in preventing the spread of health care-associated infections between patients…

Organisms found on HCW hands after such patient contact range from Klebsiella spp., Staphylococcus aureus, Clostridium difficile, MRSA and gram-negative bacteria. However, direct patient contact is not the only way HCW hands can be contaminated. HCWs can acquire bacteria on their hands by touching contaminated surfaces in the patient environment and simply by touching a contaminated chart at the nurses’ station, according to the literature.

Washing hands before and after patient contact seems like a simple solution to prevent the spread of bacteria between patients. Most hospitals have hand hygiene policies in place that guide their employees to do just that. But it is not as simple as it seems.

“When we look at all of the things that we can do to prevent infections in the hospital, one of the most important things about hand hygiene is that it works for so many different types of organisms, and you get a lot of bang for the buck,” …“The issue is that you have to practice it at a high level of compliance for it to work. There are so many opportunities for hand hygiene, and it is difficult to get to a level of compliance where we’re able to make changes to infection rates.”” (A)

“What’s The Problem? Most germs that cause serious infections in healthcare are spread by people’s actions. Hand hygiene is a great way to prevent infections. However, studies show that on average, healthcare providers clean their hands less than half of the times they should. This contributes to the spread of healthcare-associated infections that affect 1 in 25 hospital patients on any given day. Every patient is at risk of getting an infection while they are being treated for something else. Even healthcare providers are at risk of getting an infection while they are treating patients. Preventing the spread of germs is especially important in hospitals and other facilities such as dialysis centers and nursing homes.” (B)

“How much hand hygiene is enough? Guidelines vary, but according to Dr. Clifford McDonald, associate director for science at the CDC, nurses or doctors in the intensive care unit may have to clean their hands over 100 times in an eight-hour shift.

SCVMC and many other hospitals are working on ways to increase compliance. One strategy involves publicizing compliance data — apparently, some hospital departments enjoy some healthy competition.

Another study being presented at APIC from the Henry Ford Health System in Detroit found that hand-washing rates improved after hospital staff members were shown images of millions of bacteria found on common surfaces. Appealing to human emotions — like disgust — seems to have had a meaningful impact.

On May 5, the CDC launched a “Clean Hands Count Campaign” to promote hand hygiene adherence in hospitals. Part of their mission is to empower patients to hold healthcare workers accountable for cleaning their hands.

McDonald encourages patients to remind doctors and nurses to sanitize their hands — even though it might feel like an uncomfortable shift in the traditional power dynamic.

“If we can get the patients more involved in that — and get them to be able to speak up, that is really the main thing,” he said. “A lot of patients are nervous about that kind of thing — that’s another culture we’re trying to change.”” (C)

“My colleagues and I have been studying how to prevent hospital infections for years. Our research – which has included site visits to over 50 U.S. hospitals as well as a large-scale collaborative effort involving over 1,000 U.S. hospitals and several hospitals in Japan and Italy – found that opposition to hospitals’ infection prevention initiatives comes from a type of health care worker that we classified as active resisters.

Active resisters are people who like doing things a certain way for the simple reason that things have always been done that way. During one site visit, an infectious diseases doctor involved in preventing infections told us:

Getting the surgeons to adopt things in general is problematic …they’re like baseball players, they’ve got superstitions…in their minds if it’s working, why should we change it.

But at least you know who these people are since they speak up at meetings and actively resist changing behavior.

Active resister or organizational constipator?

The second type are what we termed organizational constipators. These individuals often have nothing against an initiative per se but simply enjoy exercising their power by refusing to change, albeit below the radar. The challenging aspect about organizational constipators is that the people above them think they are doing a good job, while those below them cannot believe they still have a job.

Yet another barrier we found in our research is that many hospitals have a culture of mediocrity rather than a culture of excellence. These hospitals are content to be just good enough. Leadership is generally ineffective. Overperformers are rewarded with more work…

If guidelines, personal bottles of hand sanitizer and constant feedback aren’t enough, perhaps health care workers should heed the words of Dr. Avedis Donabedian, an internationally known expert in health care quality.

In an interview about health care and how to improve it. Dr. Donabedian was clear:

Health care is a sacred mission…Doctors and nurses are stewards of something precious…Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession…If you have love, you can then work backward to monitor and improve the system.

If we have love, we will wash our hands before touching our patients.” (D)

“What is the correct hand washing technique for good hand hygiene?

It’s important that we know when to wash our hands before we consider the best technique for doing so. Hand Hygiene Australia have identified ‘5 moments for hand hygiene’ which include:

before touching a patient

before a procedure

after a procedure or body fluid exposure

after touching a patient

after touching a patient’s surroundings.

The commonly held thought is that it’s only before or after direct patient contact that it becomes necessary to wash our hands but clearly there are so many more instances where we can pick up infection carrying organisms.

One of the key risks is that the organisms are invisible and we cannot know they are there, it’s crucial that good hand hygiene becomes more than a habit but second nature.

Despite the clear need for good hand hygiene, there are many obstacles that appear to be preventing it becoming routine amongst healthcare professionals. Some of these are down to poor perception – such as patient need taking priority over hand washing, that gloves are an effective barrier or a lack of understanding of cross contamination. Whereas institutional problems can also be a barrier, such as not enough hand washing stations, staff shortages, lack of policy, or simple forgetfulness.

The battle against hospital acquired infection continues, and with antibiotic resistance ever increasing, there shows little sign of it stopping soon. Effective hand hygiene is one of the simple steps every nurse, midwife and medical professional can take to help combat infection and protect their patients from harm.” (E)

“Walk into most manufacturing plants that are performing well, perhaps winning the Malcolm Baldrige Award,1  and you will find robust leadership and management systems focused on customer needs. Good leaders establish a bedrock of values, a clear moral compass, and a compelling vision and inspire others to embrace that vision. Good managers declare goals and measures and ensure that both of these cascade through each level of the organization, with designated processes and persons accountable for them. Workers know the behaviors needed to achieve the goals, and management is visible in their work area and posts performance on key behaviors.

Health care has not yet widely embraced these management practices. Despite considerable clinical research to identify essential behaviors and practices, health care processes are unreliable, for which there are several reasons. First, we are still heavily practicing the “art” of medicine, reflecting a failure to determine when art is needed and when more disciplined science should be practiced.

Second, at most organizations, clinicians are not trained in the tools and methods of Lean, Six Sigma, and change management—which Chassin and colleagues, in their two articles in this issue of The Joint Commission Journal on Quality and Patient Safety, 2,3 refer to collectively as Robust Process Improvement® (RPI®).

Third, our accountability systems are grossly underdeveloped, and low compliance with evidence-based practices is too often tolerated.” (F)

“Five key categories of hand hygiene intervention (HHI) emerged: (1) improving awareness with education (knowledge transfer, evaluation, mentoring and feedback), (2) facility design and planning, (3) unit-level protocols and procedures, (4) institution-wide programs, and (5) multimodal interventions.

•Although some evidence-based HHI has been developed, sustaining hand hygiene compliance remains challenging.

•Components like environmental psychology, behavioral economics, and financial rewards should be used to better understand and catalyze improved behavioral change in various contexts and environments to improve hand hygiene.” (G)

“Recent trials have demonstrated that Surfaceskins, self-disinfecting door push-pads and pull-handles designed to kill deposited germs in seconds, promote hand hygiene awareness and significantly improve hand hygiene compliance.

Surfaceskins Ltd, a company part owned by University of Leeds spin off, NIRI (Nonwovens Innovation and Research Institute Ltd) believes the latest trial, conducted in hospital theaters over six months with results published in the Journal of Hospital Infection, is a watershed moment for the company, as it shows that, in addition to the potential to eliminate doors as a source of hand contamination, Surfaceskins can also have an additional infection control benefit by improving hand hygiene awareness and compliance.” (H)

“Ultraviolet sanitizing devices could be stationed around hospitals to help prevent the spread of bacteria on workers’ devices like smartphones, a small Canadian study suggests.

Researchers in British Columbia recruited staff at three hospitals to disinfect their smart devices twice daily and found a drastic reduction in the amount of bacteria growing on the devices afterward, according to the report…

Smartphones and wearable devices are becoming the medium of choice for doctors to communicate with staff and patients, Stephanie Huffman of Island Health and the University of British Columbia in Vancouver and her colleagues write in the American Journal of Infection Control.

Infections can spread by contact with unclean hands and equipment like respiratory machines, but most hospitals have hand-hygiene rules and systems in place to regularly disinfect medical instruments.

Routine and proper cleaning of smartphones and wearables such as the popular Vocera Badge has not been well explored, the study team writes. Using alcohol wipes is generally not recommended by smartphone makers.” (I)

“Two hospitals in Singapore believe they have developed a more effective hand hygiene program by focusing on handwashing compliance throughout entire wards instead of just from staff member to staff member.

Ng Teng Fong General Hospital and Jurong Community Hospital launched new hand hygiene programs a few years ago using World Health Organization (WHO) guidelines, and the results are encouraging, reports Infection Control Today.

As part of the program, staff trained in WHO methods audited administrative staff that were not members of the ward staff, as well as infection control liaison nurses and infection control nurses. Wards that didn’t reach targeted compliance rates within the first month were asked to increase their hand hygiene education. If the heightened education didn’t yield results after the second month of monitoring, then the infection committee chairperson was asked to take over the education. In the event of a third month of failure, a special task force comprised of a doctor or nurse was created to implement a compliance improvement strategy.

No ward exceeded four months of being below its compliance target.” (J)


PART 4. CANDIDA AURIS. “.. nursing facilities, and long-term hospitals, are…continuously cycling infected patients, or those who carry the germ, into hospitals and back again.”,

Renaissance Master Caravaggio Didn’t Die of Syphilis, but of Sepsis,

“President Garfield didn’t die from an assassin’s bullet, but rather from a doctor’s dirty hands.”,

It’s okay and important to ask your doctor “DID YOU WASH YOUR HANDS?”,