Editor—The Handwashing Liaison Group states that hand washing habits among hospital staff could be improved.1 This statement can be extrapolated to include those working in primary care. From January to March 1999 a computer randomised sample of 230 doctors registered with the Scientific Organisation of Flemish General Practitioners was interviewed by telephone, and 200 took part. They were asked if they washed their hands after each contact with a patient. A total of 126 of those asked washed their hands after each consultation, but only 43 did so after each home visit, although they were confronted during consultation and home visit with 45 and 85 patients with infectious disease respectively. Of those who did wash their hands after consultation, 79 used water and soap. Only 21 used a towel for single use. The table shows the reasons for not washing hands.
Age and sex had no statistical influence on the frequency of hand washing. The doctors working in groups washed their hands less often than those working on their own (consultation: 22/52 (42%) v 104/148 (70%), P=0.0006; home visit: 5/52 (10%) v 37/147 (25%), P=0.03 (χ2 test, Yates corrected)).
These results show that especially during home visits general practitioners have difficulties in organising hand washing, even when they know that they are treating a patient with an infectious disease. Some older patients still offer their family doctor a basin with soap and a clean towel, but this custom is disappearing. General practitioners working on their own may be more accustomed to include hand washing in their daily routine. The time loss is relative: during hand washing you can continue your conversation with the patient.
General practitioners must become more aware of their role in transmitting infections from one patient to the other and must train themselves to make hand washing a routine action. Students should practise this early during their medical education in order to learn good hand washing practice.2 During home visits patients can help by reminding the doctor or offering him or her the opportunity for hand washing after the examination.3 Alcohol gel can be used as a good alternative to decontaminate the hands after a home visit.4 It is effective (if the hands are not dirty), quick, and easy to use. Irritation of the skin or dermatitis can be prevented by using hydrating soap formulas, hand cream, or gloves.5
Table.
Doctors' reasons for not washing their hands
| Reasons | Consultation (n=74) | Home visit (n=157) |
|---|---|---|
| Too complicated to ask patients for facilities | N/A | 49% |
| Washed hands in car or consultation room after visit | N/A | 10% |
| No infectious contact | 46% | 16% |
| Hand washing not a habit | 15% | 10% |
| Lack of time | 12% | 6% |
| Forgotten | 14% | 3% |
| Afraid of irritation of the hands | 5% | 0 |
| No idea or no answer | 8% | 6% |
N/A=not applicable.
References
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