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How often do you wash your hands?

Quote:

Selling Soap
By STEPHEN J. DUBNER and STEVEN D. LEVITT
The Petri-Dish Screen Saver
LINK
Leon Bender is a 68-year-old urologist in Los Angeles. Last year, during a South Seas cruise with his wife, Bender noticed something interesting: passengers who went ashore weren’t allowed to reboard the ship until they had some Purell squirted on their hands. The crew even dispensed Purell to passengers lined up at the buffet tables. Was it possible, Bender wondered, that a cruise ship was more diligent about killing germs than his own hospital?

Cedars-Sinai Medical Center, where Bender has been practicing for 37 years, is in fact an excellent hospital. But even excellent hospitals often pass along bacterial infections, thereby sickening or even killing the very people they aim to heal. In its 2000 report “To Err Is Human,” the Institute of Medicine estimated that anywhere from 44,000 to 98,000 Americans die each year because of hospital errors — more deaths than from either motor-vehicle crashes or breast cancer — and that one of the leading errors was the spread of bacterial infections.

While it is now well established that germs cause illness, this wasn’t always known to be true. In 1847, the Hungarian physician Ignaz Semmelweis was working in a Viennese maternity hospital with two separate clinics. In one clinic, babies were delivered by physicians; in the other, by midwives. The mortality rate in the doctors’ clinic was nearly triple the rate in the midwives’ clinic. Why the huge discrepancy? The doctors, it turned out, often came to deliveries straight from the autopsy ward, promptly infecting mother and child with whatever germs their most recent cadaver happened to carry. Once Semmelweis had these doctors wash their hands with an antiseptic solution, the mortality rate plummeted.

But Semmelweis’s mandate, as crucial and obvious as it now seems, has proved devilishly hard to enforce. A multitude of medical studies have shown that hospital personnel wash or disinfect their hands in fewer than half the instances they should. And doctors are the worst offenders, more lax than either nurses or aides.

All of this was on Bender’s mind when he got home from his cruise. As a former chief of staff at Cedars-Sinai, he felt inspired to help improve his colleagues’ behavior. Just as important, the Joint Commission on Accreditation of Healthcare Organizations would soon be inspecting Cedars-Sinai, and it simply wouldn’t do for a world-class hospital to get failing marks because its doctors didn’t always wash their hands.

It may seem a mystery why doctors, of all people, practice poor hand hygiene. But as Bender huddled with the hospital’s leadership, they identified a number of reasons. For starters, doctors are very busy. And a sink isn’t always handy — often it is situated far out of a doctor’s work flow or is barricaded by equipment. Many hospitals, including Cedars-Sinai, had already introduced alcohol-based disinfectants like Purell as an alternative to regular hand-washing. But even with Purell dispensers mounted on a wall, the Cedars-Sinai doctors didn’t always use them.

There also seem to be psychological reasons for noncompliance. The first is what might be called a perception deficit. In one Australian medical study, doctors self-reported their hand-washing rate at 73 percent, whereas when these same doctors were observed, their actual rate was a paltry 9 percent. The second psychological reason, according to one Cedars-Sinai doctor, is arrogance. “The ego can kick in after you have been in practice a while,” explains Paul Silka, an emergency-department physician who is also the hospital’s chief of staff. “You say: ‘Hey, I couldn’t be carrying the bad bugs. It’s the other hospital personnel.”’ Furthermore, most of the doctors at Cedars-Sinai are free agents who work for themselves, not for the hospital, and many of them saw the looming Joint Commission review as a nuisance. Their incentives, in other words, were not quite aligned with the hospital’s.

So the hospital needed to devise some kind of incentive scheme that would increase compliance without alienating its doctors. In the beginning, the administrators gently cajoled the doctors with e-mail, faxes and posters. But none of that seemed to work. (The hospital had enlisted a crew of nurses to surreptitiously report on the staff’s hand-washing.) “Then we started a campaign that really took the word to the physicians where they live, which is on the wards,” Silka recalls. “And, most importantly, in the physicians’ parking lot, which in L.A. is a big deal.”

For the next six weeks, Silka and roughly a dozen other senior personnel manned the parking-lot entrance, handing out bottles of Purell to the arriving doctors. They started a Hand Hygiene Safety Posse that roamed the wards and let it be known that this posse preferred using carrots to sticks: rather than searching for doctors who weren’t compliant, they’d try to “catch” a doctor who was washing up, giving him a $10 Starbucks card as reward. You might think that the highest earners in a hospital wouldn’t much care about a $10 incentive — “but none of them turned down the card,” Silka says.

When the nurse spies reported back the latest data, it was clear that the hospital’s efforts were working — but not nearly enough. Compliance had risen to about 80 percent from 65 percent, but the Joint Commission required 90 percent compliance.

These results were delivered to the hospital’s leadership by Rekha Murthy, the hospital’s epidemiologist, during a meeting of the Chief of Staff Advisory Committee. The committee’s roughly 20 members, mostly top doctors, were openly discouraged by Murthy’s report. Then, after they finished their lunch, Murthy handed each of them an agar plate — a sterile petri dish loaded with a spongy layer of agar. “I would love to culture your hand,” she told them.

They pressed their palms into the plates, and Murthy sent them to the lab to be cultured and photographed. The resulting images, Silka says, “were disgusting and striking, with gobs of colonies of bacteria.”

The administration then decided to harness the power of such a disgusting image. One photograph was made into a screen saver that haunted every computer in Cedars-Sinai. Whatever reasons the doctors may have had for not complying in the past, they vanished in the face of such vivid evidence. “With people who have been in practice 25 or 30 or 40 years, it’s hard to change their behavior,” Leon Bender says. “But when you present them with good data, they change their behavior very rapidly.” Some forms of data, of course, are more compelling than others, and in this case an image was worth 1,000 statistical tables. Hand-hygiene compliance shot up to nearly 100 percent and, according to the hospital, it has pretty much remained there ever since.

Cedars-Sinai’s clever application of incentives is certainly encouraging to anyone who opposes the wanton proliferation of bacterial infections. But it also highlights how much effort can be required to solve a simple problem — and, in this case, the problem is but one of many. Craig Feied, a physician and technologist in Washington who is designing a federally financed “hospital of the future,” says that hand hygiene, while important, will never be sufficient to stop the spread of bacteria. That’s why he is working with a technology company that infuses hospital equipment with silver ion particles, which serve as an antimicrobial shield. Microbes can thrive on just about any surface in a hospital room, Feied notes, citing an old National Institutes of Health campaign to promote hand-washing in pediatric wards. The campaign used a stuffed teddy bear, called T. Bear, as a promotional giveaway. Kids and doctors alike apparently loved T. Bear — but they weren’t the only ones. When, after a week, a few dozen T. Bears were pulled from the wards to be cultured, every one of them was found to have acquired a host of new friends: Staphylococcus aureus, E. coli, Pseudomonas, Klebsiella.. . .

Stephen J. Dubner and Steven D. Levitt are the authors of “Freakonomics: A Rogue Economist Explores the Hidden Side of Everything.” More information on the research behind this column is at www.freakonomics.com.

Weird how I was thinking this very topic this morning since I'm not feeling well and am conscious of how me being sick will affect the people I meet today.

How often do you wash your hands? Do you wash your hands when you go to public toilets even when no one is around? Do you do it just for the "courtesy wash" when someone is? Do you wash your hands in your own home?

I wash my hands about 4-5 times per day and that's not just from going to the bathroom. I for one am meticulous about washing my hands. I wash them all the time to the point of almost obsession. I have caught myself lately not washing my hands at home after visiting the toilet usually after urinating. But when cooking, I can wash my hands 4-5 times just throughout the cooking process. I just don't like the "dirty" feeling I have from touching things that make my hands feel icky.

I wash them pretty obsessively at home - after touching anything remotely resembling garbage, or garbage cans, etc. At work, mostly just when I arrive and when I use the facilities. I'll wash more if there are sick people around, or if I'm sick. But otherwise... I'm mostly only touching paper so I don't worry so much.

But maybe I'll change my habits, hmm? Wow.

The main reason doctors don't these days is gloves.

With latex gloves being a requirement (unlike prior to the early 80's) you feel less need to constantly wash your hands. Its also VERY annoying trying to put on the gloves with damp hands as they stick.

The article missed the obvious, at least obvious to me as a doctor.

Basically, every time I go to the can or change a diaper. So, pretty frequently, but I've never counted.

I used to be pretty lax about hand washing, and that was true even when I worked in a hospital lab and handled tubes of blood, mucus, etc. However, after taking a job as an in-home healthcare aide, I became totally strict about hand washing. I wash my hands about 6-10 times a day now, even when I'm not working. After the bathroom, before and during cooking, and before I eat are three of the times I really feel like I "have to" wash my hands.

I try to wash my hands after I use the restroom or when I have to fix a computer, before and after. Just because I don't want dirt on the hardware.

I wash my hands every time I use the restroom, and then immediately put lotion on. The anti-bacterial soap they have in there dries out my hands. I wash before and after preparing a meal and any other time my hands get dirty. I never really counted how many times this happens in a day.

At work, I wash my hands about 10-15 times per shift (7 hour shifts). At home I wash them after I use the restroom, and usually when I wake up in the morning. It's pretty disgusting how many restaurant/service employees don't wash their hands...I've been in too many restaurants to count where I was in the restroom and watched an employee walk in, take a piss, and leave without washing their hands, while I'm standing their watching.

I've been called obsessive about my hand cleanliness, but that's okay. To answer the question, I wash all the time. This is a big part of my life. Red doesn't grimmace at me anymore when I ask him if he washed his hands when he is working in the kitchen. Even if he just washed them, he will wash again just so I will not worry about it. When we are in public, I don't touch doorknobs and I don't shake hands....if I can avoid it. Red handles the doors. If I do have to touch something that I am not sure about or if I can't avoid a handshake, I have cleaning supplies in my car at all times. And I don't use public restrooms, if I can help it. So, I'm not just obsessive about handwashing, I am also obsessive about germs. But it goes hand in hand.......

Until I worked in a school and was constantly getting sick, I was a 'rinser', not a washer. Now I not only wash my hands constantly, I have antibacterial hand lotion, antibacterial washless lotion in my car at all times and in public restrooms, I get my towel first, then wash and most times then use the towel to open the door.
I've read that all that washing with antibacterials is actually not a good thing, but I've taught my kids the same dilligence and they're pretty damned healthy-they barely even get mild colds.
My doctor is a constant handwasher(she will wash them no matter what the exam is, before and after) and my dentist washes then puts on the gloves.
There's one cashier at work who wears latex gloves at her register-haven't asked why yet, but seeing how people do things like try on shoes barefoot, sneeze into their hands then handle merchandise, I have a feeling why she does it.
Speaking of sneezing into hands, we need a nationwide campaign to tell folks to STOP that. Sneeze into your elbow or a tissue, please!!

I'm not sold on the anti-bacterial soap/gel thing. We do carry bacteria and other microbes on our skin that are harmless to us, and perhaps even neccessary, so it might be overkill to use more than soap and water.

I wash my hands when I shit or after handling any raw meat while cooking. That's about it unless I'm doing something that gets them dirty or if they feel kinda dirty. I'll do a courtesy wash or rinse after peeing if a co-worker is in the restroom but otherwise, I don't bother. I don't see that holding your dick for 30 seconds causes you to get any more significant dangerous bacteria on you. If it was so bad then people should thouroughly shower before having and sex (especially oral). Who does that?

Overall, I think it's weird to be obsessive about handwashing.

As Grancey said, I wash my hands more than I was going to.

I have noticed a rather defiant outrage among people who don't wash their hands very much. They seem threatened by those of us who do wash hands a lot, and they feel obligated to "convert" us by referencing studies showing that germs are good for you when you're a small kid, and blah blah blah. Keep in mind that everyone's body is different, and a headcold that might be a small inconvenience to some could be potentially devastating to others. Therefore, don't get your panties twisted crooked just because some of us prefer to remain clean while eating.

And yes, this means I will not shake your hand if I'm about to eat, so don't bother to stick it out there.

I'm not obsessive about it. I wash for the typical reasons and after any contact with an animal. I'm not phobic, I'm allergic.

We have some hand sanitizer at the circulation desk at work and I use that quite a bit because most of the stuff that comes through is pretty gross.

Quote:

Originally Posted by kutulu

I don't see that holding your dick for 30 seconds causes you to get any more significant dangerous bacteria on you. If it was so bad then people should thouroughly shower before having and sex (especially oral). Who does that?

Overall, I think it's weird to be obsessive about handwashing.

Your dick is probably cleaner than your hand. The problem lies in everything you touch on your way to (and from) the restroom. If one took a dump and left without washing, you'll get your hands covered in his rectal bacterias. The coworker with the flu who sneezes in his hands before going to the restroom shure touches the same parts you touch. Then you pick your nose, rub your eyes or stick your fingers in your mouth.....

At home I'm relaxed about washing my hands, but the more public a place is, the more I wash my hands. I'm no scrubbing maniac but I wash my hands good - under my nails and my wedding ring also. Once my hands are clean I use uther parts of my body on my way out (toes, knees, elbows etc)

One thing I didn't answer was how often I wash my hands which even outside of work is all the freaking time.

I just hate having dirty hands, its not a germ issue, I just feel better when they are clean. I get nasty migranes at times and one thing I noticed when I was in college having a bad day with them was my hands had an odd, almost petrolium smell. No idea if its just normal skin oils or something unusual but I washed my hands and I started to feel a lot better. Migranes screw with your sensory organs and I have a sensative nose to start with so maybe I'm just smelling things differently when I have a migrane.

Edit:I really need a proof reader.

I wash my hands when they are dirty. If I have been working in the yard or on my car, if I had been changing a diaper, blowing my nose, using a restroom (holding your wang for 30 seconds might not be dirty, but wiping your a$$ is a different story), cooking; things of that nature. I wash them with warm water and regular soap. I only use antibacterial soap when I have been working with raw meat, garbage, or children (other than my daughter, I know she's clean).

Oh, there's a Jehova's Whitness at the door!!! I'm going to get my Bible and have some fun.

I work with small children so I wash my hands a lot. I've been working on teaching them to do the same.

I've worked in food preparation in the past and so I am a bit obsessive about handwashing during the cooking process. Outside of the kitchen and cooking, I wash my hands after using the restroom and after handling anything gross. I also wash them several times while I am working because the kids almost always have runny noses or something that I have to wipe or handle.

I try to avoid using antibacterial anything (handsoap, wipes, toothpaste) because I'm allergic to most strong antibiotics and I would like to keep my ability to use amoxicillin instead of the ones that make me extremely sick. Similarly, I avoid taking antibiotics unless I really really need to.

Quote:

Originally Posted by willravel

Oh, there's a Jehova's Whitness at the door!!! I'm going to get my Bible and have some fun.

Let us know how it went.

I wash my hands about 5-6 times a day and use a hand sanitizer around 6-7 times a day. When I'm sick the hand sanitizer gets used a lot more. I really don't want to get others sick.

Quote:

Originally Posted by frogza

Let us know how it went.

I got a good one. I tried to counter-convert him to Christianity. I got him to coceede on the points of the existence of hell (thanks in no small part to Matthew 25:41) and the nature of the holy trinity (thanks to Colossians 2:9 and Matthew 28:19). I was starting to grill him on the Jehova's Whitness litteral interpretation of the 144,000 being kings and Noah's flood vs. the non-litteral interpretation of the 7 day creation not actually taking 7 days, when he suddenly had to leave.

Next time, I'll try to convert the poor guy to Islam.

Ain't I a stinker?

//threadjack

Quote:

Originally Posted by warrrreagl

I have noticed a rather defiant outrage among people who don't wash their hands very much. They seem threatened by those of us who do wash hands a lot, and they feel obligated to "convert" us by referencing studies showing that germs are good for you when you're a small kid, and blah blah blah. Keep in mind that everyone's body is different, and a headcold that might be a small inconvenience to some could be potentially devastating to others. Therefore, don't get your panties twisted crooked just because some of us prefer to remain clean while eating.

About 10 years ago, I had some health problems where I had almost no immune system left. Any fever meant hospitalization. I was really good about washing my hands, but couldn't figure out why I kept getting sick, until I was in a public restroom one day and saw someone leave without washing their hands. After that, I became pretty obsessive about it and I still am. As a result though, over the last few years, I can only remember getting a cold once. I haven't gotten quite to the point of being like Monk, but I'm always very careful before I eat anything.

Any contact (or anticipated contact, or near-contact) with food or poo (anybody's) causes a lot of washing on my part.

twice or more depending on how dirty I get at work

I'd guess between 30 and 40, but I'm far from obsessive about it. I just like to have clean hands and not be spreading germs around.

Every time I use the restroom I wash and sanitize.
Before leaving for class.
After returning from class.
Before eating.
After touching raw food, and before touching any other food especially raw meats, so usually 6-8 times during the cooking process.
Before and after using the computer (keyboard).
Before leaving to drive somewhere and after arriving.
Before and after cleaning something.
Before handling something I want to keep clean, especially a book, comic, dishes, etc.
After touching anything resembling garbage or any cleaning utensil such as a broom, dustpan, sponge, etc.

Gilda

10-15. But I've never counted. Most people consider my hand washing over the top. So maybe its more if gilda is really washing between 30-40. I wash em when ever they feel dirty, or whenever I know they got dirty, like going to the bathroom.

I hate assholes who dont wash their hands. Especially when theyre sick.

I'd say I wash my hands 15-20 times a day. I wash (WASH) them every time I use a public restroom and give people dirty looks if they don't. Yeah, I'm that guy.

Like some other people have mentioned, when I'm at home I wash my hands pretty compulsively. If I ever feel at all dirty, I go wash my hands. I go through a lot of hand soap.

I wash my hands whenever I feel they need to be washed. This usually includes after the bathroom, before eating, after eating, in-between cooking, etc.

I guess I do it often then!

I haven't really counted, but I wash my hands between "quite a bit" and "my coworkers are convinced I have OCD" depending on where I'm posted for the day. I also have a borderline obsession with hand sanitizer.

At home I do not wash them nearly as often, and very rarely use hand sanitizer.

here in the Rio Grande valley the ladies hug and the men shake hands---it's just an old hispanic tradition. of coarse this is the same area where a lot of the older generation do not flush the paper down the toilet...setpic tanks....SO...

we wash our hands a LOT, and we carry waterless hand cleaner with us, and use it after every function, shopping trip or going to eat....our illness have been kept to a minimum....VG

I wash my hands a few times a day but I'm not always thinking about it. I wash when I use the bathroom and when cooking several times, or whenever my hands are dirty. I own two cats so it's pretty hard to be that obssessive about it, I mean I must eat cat fur on a regular basis! :D

I wash my hands before and after using the restroom, but that's because I work as a bike mechanic and a lab assistant, both dirty your hands and I'm not touching myself down there with dirty hands, why don't more people do this??? Do you really like to touch yourself down there with dirty hands???

Probably 10-15 times a day. I shake a lot of hands during the course of a work day.

Basicallt I only wash them before I am going to eat, and sometimes I forget, so I suppose I don't wash them nearly enough. Oh well "shrug".

anytime before I handel food. In between handeling meats and other foods or instruments to manipulate the meat (knives). After any time I use the wash room (which I find disturbing here that people don't wash their hands after using the bathroom, either number 1 or 2!). I dread touching the doorknob to exit the place, lucky for me the doors are all push doors at my school

When I come home after being out, I wish my hands. I also wash my hands before I play guitar

Quote:

Originally Posted by jth

Forgot, I do wash them after going number two, but not always after number one, but do remember to wash them before I eat, sometimes anyhow. Yeah, lot of bad germs out there. Better that then to become obsessed about it thought you ask me. I seen too many people who wash their hands a hundred times a day and won't touch other people, so I ain't too worried.

I'm pretty obsessive about how many times I wash my hands. I wash before and after I use the bahtroom, if it were convienient, I'd wash my hands during.
Then again, I work in the kitchen of a homeless shelter, so it's for my own safety just as much as it is for theirs. Any time before and after I handle food, which is several dozen times a day, I make sure I'm clean. According to the rules, I should be washing my hands every time I so much as touch my hair, but I'm not that obsessive.
I don't think I need to be washing myself that much, but I think that if I was found responsible for a dead homeless person, I might be out of a job so.....

im like jay-g.

i dont think im obsessive. well some people maythink so, but not me.

ill wash my hands at least 20 times a day. especially at home or when i get home. before i eat..usually 3-5 times a day. after using the bathroom - 2-3 times a day, touching money, public toilets, handles, handshakes, elevator buttons, handrails, pedestrian buttons, whenever i handle food or cook anything. ill wash my utinsels before i eat with them too.

Before eating and typically after, so thats 5-6 there.

Bathroom visits, can range from 2-6 depending on how well the stomach is doing.

Any sort of food preperations for dinner, this can be at least 1 or upwards to 4-5 depending on what I'm cooking.

If I had ANY run in with someone who is sick, touched something of mine, etc I will most certaintly wash my hands asap and wipe down the object they touched with disenfectant.

If I'm at work, I deal with money, computers, other people, so thats a good 3-5 a day.

So thats what, a good 18+ a day on average?

Am I compuslive? No, I just grew up with a father that if he got a cold it would be like a normal person getting a 2 week long flu.

Its just health concious.

In general, fairly frequently. I enjoy the feeling of clean hands.

When at work at the pharmacy, constantly (which includes the germ-killing substances like the Purell).

When I was doing my clinical rotations to be an EMT- obsessively. This also includes the use of germ-killing substances like Purell, or the foam-style the hospitals here seem to use a lot (which are great).

Quote:

Originally Posted by Ustwo

I find it way more than very annoying. lol

Anyhow, yeah, one thing we were told very early on in the program is that the gloves will give us a false sense of general protection. The real issue is, you use gloves to do things with the patient, but then you take them off and touch everything else in the entire hospital or ambulance without them. lol

So yeah, my hands are practically sterile all day when i'm working. lol