Aim higher, reach farther.


Infections picked up in hospitals, nursing homes and doctor's offices affect more than 1 million patients and are linked to nearly 100,000 deaths a year.


It's a simple enough request, but for patients and families who feel vulnerable, scared or uncomfortable in a hospital room, the subject can be too intimidating to even bring up with a doctor or nurse: Have you washed your hands?


Strict hand hygiene measures are the gold standard for reducing infections associated with health care. Acquired primarily in hospitals but also in nursing homes, outpatient surgery centers and even doctor's offices, they affect more than one million patients and are linked to nearly 100,000 deaths a year, according to the Centers for Disease Control and Prevention.

The CDC aims to engage both patients and caregivers in preventing dangerous hospital infections. ENLARGE
The CDC aims to engage both patients and caregivers in preventing dangerous hospital infections. Centers for Disease Control

Yet despite years of efforts to educate both clinicians and patients, studies show hospital staff on average comply with hand-washing protocols, including cleansing with soap and water or alcohol-based gels, only about 50% of the time. Two new studies show patients aren't much more comfortable today than a decade ago with the idea of asking doctors and medical staff to lather up.

Hospitals have reduced certain infections over the past four years with measures such as removing unnecessary catheters and washing a patient's skin before surgery with antibacterial soap. Some have lifted hygiene compliance to nearly 100% with strict "wash in, wash out" protocols, and some have designated unidentified staffers to secretly monitor co-workers. Some hospitals link merit increases to compliance and temporarily suspend clinical privileges of doctors who ignore the rules, says Gina Pugliese, vice president of the Safety Institute at hospital purchasing alliance Premier Inc. According to a 2010 study, a disciplinary program at the University of Kentucky Medical Center in Lexington that included suspending doctors' privileges led to improved compliance rates.

More hospitals have turned to electronic sensors, thermal imaging and video cameras to monitor hand hygiene, and some are issuing badges that wirelessly record staffers' use of hand hygiene stations before entering a patient room. Some monitoring systems emphasize patient engagement and sound an electronic alert to remind patients to speak up when a staffer enters the room.

A CDC poster aims to raise patient awareness of the role of hand washing in preventing infection and encourages patients to speak up to hospital staffers each time they enter the room. ENLARGE

The CDC has provided 16,000 copies of a video, titled "Hand Hygiene Saves Lives," to be shown to patients at admission. In one scenario, a doctor comes into a room and the patient's wife says, "Doctor, I'm embarrassed to even ask you this, but would you mind cleansing your hands before you begin?" The doctor replies, "Oh, I washed them right before I came in the room." The wife says, "If you wouldn't mind, I'd like you to do it again, in front of me."

After patients at 17 hospitals run by Cincinnati-based Catholic Health Partners watched the video, there was a rise in both the proportion of patients asking staffers to wash their hands, and physicians and nurses reporting that they were asked, according to a 2010 study. "Hand hygiene is probably the most important thing health-care workers can do to protect their patients from infection," says John Jernigan, director of the CDC's hospital infection-prevention efforts who appears in the video. When patients speak up, it helps create "a culture of safety," he says.

The nonprofit Association for Professionals in Infection Control and Epidemiology is kicking off a campaign this month including posters mailed to 15,000 hospitals with tips on how patients can take an active role. It suggests asking staff about hand hygiene and requesting that hospital rooms be cleaned if they appear dirty.

"We've been focusing on intensive interventions to improve hand hygiene among health-care workers for decades, yet we've really shown very little progress," says Carol McLay, a Lexington, Ky., infection prevention consultant and chair of the committee that designed the campaign. "We are trying to empower patients and families to speak up and understand their role."

At some hospitals, posters, bedside placards and buttons for staffers say, "Ask me if I've washed my hands." Susan Coffin, a pediatric infectious disease physician at the Children's Hospital of Philadelphia, says while many efforts are made in good faith, they are "insufficient to overcome some of these barriers." She is co-author of a study, published in June in the American Journal of Infection Control, which found that 84% of parents were aware of infection risk yet only 67% would remind a health-care worker to wash their hands, most often because of concern about appearing rude or undermining authority. Yet 92% of parents said if a health-care worker invited reminders, they would be more likely to do so. The hospital is "trying to make it a more active conversation," Dr. Coffin says. Admission packets offer detailed information on hand hygiene and nurses tell families that staffers welcome questions about hand washing.

In a study published in September in the journal Infection Control and Hospital Epidemiology, one-third of patients surveyed at the University of Pittsburgh Medical Center said they observed doctors failing to wash their hands, but nearly two-thirds said nothing to their doctor about hand hygiene. Most didn't believe it was their role to do so and said they felt embarrassed or awkward and worried about reprisal.

Patients are more likely to ask nurses about hand hygiene, says Gregory Bump, associate professor of medicine. "There is something about the white-coat barrier that makes them reluctant to challenge doctors." Physicians may resist assertive patients and seem unreceptive or even hostile to a question about hand washing, he says.

Patients, instead of receiving information about infections and hand washing, would prefer having staffers wear a button or light to indicate whether his or her hands had been washed, the study also found. UPMC is developing a system to measure and track hand-washing compliance, as well as computerized verbal reminders to patients to ask the employee to clean their hands when they enter the room.

Michael Gettes, 50, has been hospitalized several times and says he has never had to remind Dr. Bump, his primary physician, to wash his hands. He has asked other hospital staffers to do so. One doctor reacted negatively. "It put our relationship on a bad footing," Mr. Gettes says. "Yes, you run the risk of upsetting someone who has been taking care of you. But it is my life. If they make a mistake I am impacted or I die."

Gail Ulager, a 72-year-old kidney transplant recipient at UPMC, says she worries about the possibility of infection because she is taking drugs that suppress her immune system to prevent rejection of her new organ. She found a way to give the message to doctors, nurses and even her dentist without seeming disrespectful. "I always tell them that the transplant center insists that everyone washes their hands" she says.

Write to Laura Landro at

Anthony Zipple
Anthony Zipple subscriber

Lack of hand washing clearly kills far more people each year in the US than terrorists. The same is true for food poisoning. It is interesting that we get so focused on some things and ignore low hanging fruit like this.


From wife of Howard:

Care has deteriorated so much in hospitals in recent years, that whenever a member of our family is hospitalized, one of us is always there to supervise, making sure medication is correct, the IV is attended to, the correct meal was delivered, and so on. Now they want us to remind them to wash their hands, too?

Hospitalized patients are too sick to notice if staff is doing their jobs, and they should not be expected to do so. By the time a patient is well enough for that nowadays, he or she is usually sent home, sometimes sooner.

Lord Lucan
Lord Lucan

It's strange that not one initiative mentioned in this article has addressed the issue of dirty/infected scrubs. The U.S. is the only country outside of the third-world where I have witnessed doctors and nurses wear their scrubs outside of the clinical environment. It seems to be a social norm here. Elsewhere, staff are forbidden from wearing clinical clothing anywhere but within the clinical environment. They go to work, and change from their personal clothing into their clinical, then back again. The scrubs and coats never leave the hospital.

When quizzed about this oddity, the excuse often given is that the doctors and nurses are not given adequate/any changing facilities at the hospital, but I am not sure that this is true. Is it a lack of facility, or simply laziness or ego that causes clinical staff to wear clinical clothing outside of the environment?

Clinical personnel can wash their hands all they like, but when they wear the same scrubs and coats for days on end, including out on the streets, in the cafeteria etc, this also poses a great risk to patients, not to mention the outside world, when they carry things on their scrubs/coats onto the streets.

So, why is this not a consideration to the authorities, but especially the clinicians themselves?!

Jan Clarence
Jan Clarence

It shouldn't be the patient's job, but there are those who need to be reminded. Any.physician or health care provider working in a hospital who reacts negatively to a hand hygiene request (I just did that outside!) should be reported, and hospitals should make that clear to patients when they arrive at the hospital. No neckties, please, Doc, and by the way, please don't wear your "scrubs" around town.

Patricia Rogers
Patricia Rogers

My goodness, isn't it medicine 101 that hand hygiene is the most important thing health care professionals can do to keep infection at bay? A doctor may be able to perform a perfect procedure, but if bacteria enters, it's all for nought.

Cade Brighton
Cade Brighton

I think that doctors should wash their hands all the time. In fact I think that for the most part we all could wash our hands a little more and it wouldn't hurt anyone. I think that the bigger issue comes from over all patient satisfaction and health if Doctors are not washing their hands what other shortcuts might be taken to save time? Are healthcare providers doing what they can to track patient issues and the general over all health of that patient? If doctors are not washing their hands I would be interested to know how many of them are using some kind of healthcare CRM to track patients over all health. This company offers a healthcare crm If doctors don't wash their hands are they taking shortcuts other places too?

Louise Stonington
Louise Stonington subscriber

In 1847 Ignaz Philipp Semmelweis, a Hungarian physician in Vienna, got doctors to wash hands and instruments in chlorine water and reduced deaths during childbirth in his hospital from 13% to 3%.
Doctors at that time blamed disease on ‘humours’ in the human body and refused to accept their responsibility for high death rates. Semmelweis moved to another city, where he continued his methods and wrote up his studies, but other doctors were critical, defensive and resistant. He was committed to a mental institution and died there of the same infection that he had prevented from killing thousands of mothers.
The year of Semmelweis’ death, Lister, having read that Pasteur was demonstrating infection caused by germs, began using carbolic acid during surgery to kill germs and reduced death rates during surgery from 46% to 15%. Principles of hygiene, began to be adopted and have extended human life spans by many years.
Climate science, warning us that continuing to burn oil, coal and natural gas is causing the climate to overheat, kill millions and threaten civilization, is being ignored by many people today. Still, we have the information; if enough people insist that we take steps to change to a green, low carbon economy, perhaps we can still save ourselves.

Mark Graban
Mark Graban subscriber

It's shameful that hospitals ask patients to, basically, inspect their work. This is the job of hospital leaders (including physician leaders) and they are abdicating their responsibility.

Patients ARE afraid or nervous to speak up. So, we shouldn't try harder to encourage them to do something they don't want to do (and shouldn't have to do).

Does an airline encourage passengers to ask the pilot if they've properly set the flaps for takeoff? NO! That's the airline's job.

Does a restaurant encourage customers to ask if the chef has cooked the chicken to the proper temperature? NO! That's the restaurant owner's job.

Hospitals should be embarrassed that they are asking patients and their families to do this.

Alan Freemond
Alan Freemond subscriber

We used to teach them for a surgery scrub for 10 minutes, by the clock with ivory soap and a brush. then they got to faster scrubs with more potent agents.

Don't they teach them to even wash their hands in their office? Didn't their mothers teach them to wash their hands. huh?

Justin Hamlin
Justin Hamlin user

In this day and age of modern sanitation, we actually wash our hands TOO MUCH. That's right, TOO MUCH! Most of the time, it doesn't matter and is just for show for UNinformed patients like the author and the first commenter. For infections that are a risk, we already have contact precautions, which include hand washing.

Stefan Valica
Stefan Valica user

I always do this :-)
sometimes I even think I do too much :-)
so that I have to be careful not to do it too much :-)
otherwise it would be unhealthy :-)
LOL :-)

Helen Diamond
Helen Diamond user

Questions are fine, as long as the visit is not for something which will put the patient unconscious.

Karl Martell
Karl Martell

When my sister was having brain surgery at Mayo a couple years back, one of the things that really stood out to me was the way that _every_ room had a hand sanitizer station that _every_ staffer used before and after each patient encounter. The culture there seeped over to where every visitor was doing the same upon entering and leaving a room.

Thanks for an interesting article on the changing paradigm of care in this important regard.

Madelene Teperson
Madelene Teperson subscriber

Just more insanity...this columnist really needs to go.

James McCarty
James McCarty subscriber

What a great way to start off a doctor-patient relationship! "Hi, I'm your new patient. I'm going to begin by letting you know that I believe you to be dishonest. You are guilty until you prove yourself innocent."

Amanda Frye
Amanda Frye subscriber

In the past I've used the hand washing issue as a doctor "weed out" since hand washing is a simple basic health issue and hygiene practice. Responses and reactions to hand washing are interesting and often very telling about training and practice. One time I politely asked a pediatrician to wash her hands before she examined my child. The doctor's response was something along the line of if I washed my hands after every patient my hands would be red, rough and dry at the end of the day. Guess the pediatrician had never heard of hand lotion, but it was evident what was important to that pediatrician.

dean oestreich
dean oestreich user

Focusing on clean hands is important, but germs can be transmitted from the Doctors stethoscope, blood pressure cuff,smock or clip board. Perhaps it is not always the Doctor transmitting germs, but also the many Aids and food service people. God forbid if anyone ever took a germ culture from the furniture in the admittance area.

Kathleen Duke
Kathleen Duke user

Equally important questions to ask your doctor:

Do you accept any pharmaceutical kickbacks, directly or as "speaking fees" or research "grants"?
Do you accept any medical device kickbacks in any form?
Do you receive any revenue from the medical scans you order?
Have you advised me objectively about alternatives that you yourself don't offer?
Have you disclosed all potential conflicts of interest to me?

Robert White
Robert White

There are many issues in health care and costs. I have not had the opportunity to be a first hand observer in other countries but I have been involved deeply in patient care aspects of healthcare for more than 40 years. I have been involved in training of hundreds of personnel, been an officer of an infection control practitioner organization and lately a visitor in surgery suites about 75 times a year for surgical procedures in many different hospitals.
First be aware that protocol in many if not all hospitals and surgery centers is that personnel are to change into fresh scrubs upon returning to surgery. This is true if they have worn the scrubs outside the surgery suite or they are wearing street clothes. I do not disagree that too many times scrubs are worn inappropriately but there have been occasions where I have worn scrubs outside in a rush situation. When a patient is on the table in surgery it may be quicker to go out for a supply and change into fresh scrubs before returning to the suite. To unlock a facility-supplied combination lock on a locker containing street clothes that may be rather remote can be a time consuming project.
More to the point of this reply is the idea that, as an informed patient, you can see the hospital protocols of any situation of concern. The protocols that could answer your question may even be posted on the facility’s web site. You owe it to yourself and the rest of us to question beyond an unsatisfactory answer. In virtually all 50+ surgical facilities I visited recently there are adequate amounts of scrubs available to be able to change into if the scrubs become contaminated. If in fact the same scrubs are worn as you believe you observe, please do ask enough questions and not just make or accept a judgment that may endanger many people.
Thanks for your thoughts because we are very deeply involved with medicine – occupationally and personally. I do want to keep getting older.

Stacy Thomas
Stacy Thomas subscriber

In your last paragraph you are citing instances of proven, verifiable, testable, falsifiable scientific method in prior centuries as support for unproven, unverifiable, untestable, non-falsifiable unscientific assertions today.

Ken Belcher
Ken Belcher subscriber

Really? Have your participated in one of the seminars where ONE participant's hands have a fluorescent harmless bacteria applied, and later UV light shows almost everyone's hands have the bacteria at the end of the day? The ones with good hand washing are the ones who don't From what I have read this seminar has a startling effect on health care workers.

If you are in the field you are likely infecting patients given the attitude you express above. The 90k-100k unnecessary American deaths each year has held steady over decades, indicating the level of obstinance heath care workers have. The total harm is much greater, with 10 times as many spending one to two weeks extra in the hospital. Note this death toll far exceeds that of traffic and gun deaths combined. Terrorism, our big bugaboo, is a joke, at less than 25 American victims outside of war zones each year.

james jernigan
james jernigan

I go to Mayo regularly, and I have not been bashful about mentioning to my other Doctors that at Mayo they will re-sanitize if they turn their back on you, reach for a keyboard, or any one of a number of other trigger points. I even carry a picture of the sanitizer that they use on my phone, and my Primary Care Dr has started keeping it in each room off his office. It's a little thing, but one that makes you aware of how much stuff Mayo has covered that other places either miss or have forgotten...

Charleen Larson
Charleen Larson subscriber

Fresh gloves, donned for each patient, are surely better than relying on people to wash their hands.

Ken Belcher
Ken Belcher subscriber


"Wearing gloves does not replace the need for hand washing, because gloves may have small, in-apparent defects or may be torn during use, and hands can become contaminated during removal of gloves. Failure to change gloves between patient contacts is an infection control hazard."

Note that the implication of the OSHA statement (I found it in reference to WHO stds too) is gloves are insufficient for both patient and health care worker.

I have often seen personnel at Northwestern (NWMH) in Chicago use gloves instead of hand washing. I am sorry I did not look this up before.

Ken Belcher
Ken Belcher subscriber

You can increase the safety of you and yours a lot more by asking healthcare workers that simple question than any action the last two governments have take on terrorism.

Note the comparative toll: well over one million unnecessary American deaths (and well over 10 million unnecessary 10-14 day hospitalizations) from poor healthcare setting hygiene compared to a little over 3,000 deaths from domestic terrorism since 9/10/2001.

Where could we really save lives by spending the same number of dollars?

Stephen Morris
Stephen Morris subscriber

@ oestreich

Or perhaps a culture from a patients skin.

Wanda Sampson
Wanda Sampson

Why do you even go see doctors if they're so evil?

Hopefully your doctor will as you to go somewhere else.

Louise Stonington
Louise Stonington subscriber

Thanks for asking. A science teacher can show you a demonstration of how carbon dioxide comes from burning fossil fuels: oil, coal and natural gas, and how carbon dioxide absorbs heat and holds it in air. Do you not agree that people have burned a huge amount of fossil fuels in the last century. Measurements show that air is warmer by about 1oC now, and the oceans are gradually heating up, which is more dangerous, as they act like space heaters radiating warmth. Warmer air causes more evaporation of water, heavier clouds make more rain and snow and floods, evaporation dries fields shriveling crops, and carbon dioxide sunk in ocean water makes carbonic acid which dissolves shells of sea animals.
Check NASA, NOAA, AMS, and almost any published, accredited climate scientist for validity of these results.
As for the question of whether a low carbon economy could in fact slow the warming of the globe in time to stop the floods, droughts, wildfires, release of methane, slowing of ocean currents, and drying of forest lands that could spiral the world climate catastrophe, unlivable for humans, I choose to believe that is true. BNEF reports show that solar and wind are now cost competitive with fossil fuel energy in many places. Around the country, states and municipalities are helping investors learn to save money and reduce carbon emissions by taking steps to make buildings more efficient.
And you are asking this question. The more people educate themselves, the closer we come to solving this problem.

Carl L. Bryant Ii
Carl L. Bryant Ii

So, if 12 people are killed by gun violence in one incident, the outcry is to ban or restrict guns. 30,000 plus or minus are killed by automobiles. Genocide in xxx (you pick, Africa, Asia, Middle East, etc.). Now 100K plus or minus due to infections. Where is the movement to ban cars, doctors or hospitals? So why do more deaths equate to such laissez faire attitudes about medical care? Where are the legions of protesters? Occupy movement? I guess it just doesn't count for much.

Thank you. Carl

Carol Semian
Carol Semian subscriber

from a healthcare policy stand point, there seems to be a contradiction here:

1. For hygiene in the hospital, wash your hands but gloves are optional.
2. For safe sex, wear a condom but there is no mention of washing before and afterwards

Creating a physical barrier between two people contacting one another makes a lot of sense. Washing, then contaminating, then washing? How about Just throw away the gloves between patients so neither person gets contaminated at all?

And that government speak of imperfections in gloves, I would be interested in asking the glove manufacturers about the imperfections in their gloves and hearing what they have to say about that.

And of course, using the same gloves as you contact one patient after another is ludicrous.

Donald A. Crane
Donald A. Crane subscriber

Standard practice on ambulance calls here in north Routt Cnty, is for all EMT's and assistants to don the blue disposable gloves before handling the patient, equipment, etc. Actually glove protection in some cases (depending on your activity) is actually more important than donning the coverall protective gear stowed in our vehicles.

Justin Hamlin
Justin Hamlin user

I know I would ask her to find another doctor whose time she can waste if she asked ME those questions.

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