Only 77% wash hands after using the toilet

How clean are your hands? How about the person who just shook yours?

Several presentations at last month's Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago suggested that people not only wash their hands less often than they say they do, but the number who really do appears to be decreasing. Also, improving hand hygiene in the health care setting saves money.

"Hands are great distributors of disease, but hand washing is a great intervention," said Judy Daly, PhD, spokeswoman for the American Society for Microbiology, which organizes this meeting. She is also director of the microbiology laboratory at Primary Children's Medical Center in Salt Lake City.

According to data from observational and telephone surveys by Harris Interactive, which were commissioned by the society as well as the Soap and Detergent Assn. and released at the meeting, 92% of adults say they always wash their hands after using a public restroom. When observed in places such as train stations and sports stadiums, only 77% actually do. This represented a decline from the 83% observed in the 2005 version of this survey.

Significant gender differences also were seen, with only 66% of men soaping up compared with 88% of women. Similar gaps between men and women also were found by other studies that examined the behavior of doctors and health care professionals.

"Very clearly, guys need to step up to the sink," said Brian Sansoni, vice president of communication for the soap association.

This issue has long concerned medical societies, patient safety organizations and public health agencies. The American Medical Association urges everyone to view hand washing as important. Experts suggest, however, that while this activity is important across the board, more payoff may be gained from programs that focus on health care settings.

"The message about improving hand hygiene is a good message to support, but we will naturally see the greatest result in the places where the sickest people are," said Dr. M. Lindsay Grayson, vice chair of Austin Hospital/Austin Health in Melbourne, Australia.

In these venues, the benefit of hand hygiene is increasingly being quantified. For instance, a paper presented by Dr. Grayson found that hand hygiene education for health care professionals along with ensuring that alcohol hand rubs were available significantly reduced the number of methicillin-resistant Staphylococcus aureus infections. In turn, this result saved his state's health system more than a million dollars.

"We need a culture change," Dr. Grayson said. "Those who provide care should feel funny walking up to a patient having not used an alcohol-based hand rub. And the patient should feel pretty funny, too."

An Argentinean study also found that upping compliance with hand hygiene recommendations in the intensive care unit reduced the device-associated infection rate from nearly 20% to just shy of 5%. A paper from Israel on a computerized program to shift infected patients into isolation more quickly combined with improvements in hand hygiene reported reductions in hospital-acquired drug-resistant infections of 45%.

But although researchers say these efforts can pay for themselves, improving hand hygiene comes with significant challenges. In Dr. Grayson's study, the urban institutions did not do as well as the rural ones because of high staff turnover.

The factors that motivate health care professionals to wash more often also might not be the most obvious ones. A study out of the University of Geneva Hospitals in Switzerland found that the opportunity to reduce nosocomial infections did not increase hand washing, but peer pressure and easy access to hand-washing facilities did.