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It Is Time for Action: Improving Hand Hygiene in Hospitals
As delivery of medical care moves increasingly to outpatient settings, patients who require hospitalization have more acute illness and heightened susceptibility to nosocomial infections. Such infections result in substantial morbidity and are estimated to cause or contribute to 80 000 deaths annually in the United States (1). Many nosocomial infections are caused by pathogens transmitted from one patient to another by way of health care workers who have not washed their hands between patients (2, 3). Although Semmelweis (4) demonstrated 150 years ago that mortality related to hospital-acquired infections could be reduced when health care personnel washed their hands with an antiseptic solution between patient contacts, compliance of health care workers with recommended handwashing practices remains unacceptably low, often in the range of 30% to 50% (5-8). Even the current spread of multidrug-resistant pathogens in hospitals has not compelled health care workers to wash their hands as frequently as recommended (8).
Why is compliance with recommended handwashing practices so poor? Many factors are involved, including lack of awareness among personnel about the situations that call for handwashing, personal and organizational attitudes toward handwashing, and various logistical barriers (6, 9, 10). Many health care workers do not wash their hands after “low-risk” patient contacts (5, 7), probably because they are not aware that their hands may become contaminated while measuring the patient's blood pressure or pulse, touching intact areas of the patient's skin, or lifting the patient (2). For reasons that are not clear, handwashing frequency varies by type of health care worker and by clinical service, and …
