Unwashed Doctors

Sir,

My career in the US Navy was a good one. I was an epidemiologist for many years, chasing disease and pestilence around the globe. I even became well versed in biological and chemical warfare (BCW) countermeasures. When I left active duty, I became a chemical action officer at Aberdeen Proving Ground, Maryland and there I developed an even healthier respect for what societies could do to each other and what could happen even by accident. My days associated with BCW led me to become very respectful of bugs and drugs (microbes and intoxicants). Eventually, I became an anesthesiologist and intensivist, and I still have a keen interest in bugs and drugs. In fact, it is sort of my business to know them intimately.

My workspace is the high-stress environment of the intensive care unit (as it is for many other physicians, nurses, pharmacists, respiratory therapists, etc.). Thus, my colleagues and I have exposures on a regular basis to low velocity missiles (sharp objects), inhaled toxins (aerosolized ribavirin), loud noises, and alarms that frequently scream, “This is not a drill, this is not a drill.” And, of course, we are exposed to biological weapons such as blood, saliva, sneezes, vomit, urine, feces, and cerebral spinal fluid, which all may contain nasty viruses and spectacularly effective bacteria of near-bio-warfare equivalence. In Navy BCW drills, Navy Medical Officers learn to don gas masks and Mission Oriented Protective Posture (MOPP) gear in rapid fashion. For in no way were we going to allow ourselves to be placed in peril or be injured, thereby putting at risk those around us who counted on our particular skills, simply because we did not know how to properly take preventive measures, or countermeasures.

In view of such experiences I, and my colleagues of like mind, are saddened as we walk through the institutions of higher medical education around the country, and find that grown men and women who call themselves “Doctor” cannot even take the time to wash their hands in the civilian equivalent of a BCW environment. I see hand washing being ignored far, far too often. My US Navy junior enlisted personnel performed better than America's “most educated”. Sarcasm aside, this is a travesty in regard to patient safety. I do not care how many papers you have published, or how many patients or dollars you draw to the hospital, you are on notice, sir or madam, that your behavior is no longer to be tolerated. Fines and suspension may face you in the days ahead.[1] Thomas Jefferson once said, “In matters of style, swim with the current, in matters of principle stand like a rock!” This applies especially to today's situation regarding hand washing.

Many of us have children, and we certainly do not want our children to acquire bad habits. We look askance at people who smoke in front of their children, we cringe when parents shout or yell or misbehave in front of children in public generally, or at sporting events in particular. If we were so concerned about role modeling for our children, why would we not wash our hands in front of our medical students or residents?[2] Remember see one, do one, teach one? Do not think for a moment that it does not apply here, and that an attending physician is not an important role model.[3,4] What is truly embarrassing is that patients‘ families now notice it, and comment on it frequently.

A culture of safety is being emphasized throughout the nation. We have gone through check lists, crew resource management, hand-offs, electronic medical records, team-building, etc., but what kind of arrogance prevents us from washing our hands when we enter a patient's room, and what halts colleagues and other health workers from pointing it out to the offenders? I have no good answer. Hand washing is one of the bedrocks of patient safety. It is a simple and effective counter-measure in a potentially hostile environment. The lack of hand washing puts our patients in harm's way. As Moliere said, “It is not only what we do, but also what we do not do, for which we are accountable.”