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Handwashing: The Clinical Blockage Factor

Mike Mann's picture

Fact-based solutions without the facts

Evidence-based solutions are driven by facts. This is the lifeblood of most clinicians. But there are no facts when it comes to handwashing, no standards of quality or frequency. Thus, what should be the role of the clinicians in raising handwashing frequency which is largely a behavior change challenge?

Handwashing in healthcare is generally poor. A variety of studies point to a 50% compliance level. All caregivers claim to be handwashing enthusiasts yet collectively they are quick to confess industry compliance numbers around 50%. They also feel that the majority of HAIs can be prevented with a timely handwash.

Consider those broad-brush estimates in the context of CDC's predicted annual mortality numbers for Acute Care at 99,000, and LTC at 380,000. Handwashing can and does save lives. Non-handwashing kills.

Clinical solutions, those with the measured science behind them, are favored when available. This is the gold standard for most healthcare interventions. Their world is flush with decision support data and clinical documentation prioritizing the path of needed actions.

Some caregivers, more common in the ranks of the medical doctors, are obsessed with the clinical approach and resist getting involved in anything based on approximation and opinions. Their indignation is evident when invited to collaborate on such trivial projects as handwashing. Without the documented science they are paralyzed and un-participative, even in this clearly life-saving venture of improved handwashing.

Anecdotes:
1. “No one has ever documented that pathogens have been transferred by a stethoscope.”

This response came from an arrogant doc whose scope had just been swabbed by a fellow doc with ATP. The reading was very elevated. His reponse was loud as if his superiority is best understood by drowning out the voices of the opposing views. To this senior medical doctor, a lack of handwashing has never been documented as the specific source of an HAI. We can count him out as a supporter of major handwashing improvements until he has the evidence documenting the direct connection between the lack of handwashing and HAIs.

2. I once had two different jobs with about the same pay at the same company. I was the Director of R&D and then the Director of Business Development. My R&D post enjoyed a higher stature within the company because I was seen as all about science. Numbers. Facts. Data. The truth.

Business Development was seen as more of an art, less formulaic and difficult to measure, at least in the short term.

The clinical bias can stifle innovation and collaboration by creating an unspoken air of superiority. I hope I never used my technical halo to put down the champions of change, the courageous “Intrapreneurs" as they created innovative ways to lead improvements, even in situations where facts were scarce. Passion, commitment and grit is what is needed now to save lives via enhanced hand hygiene.