Handwashing or Alcohol Handrub?

An article came out in the 18 Jan 2008 Straits Times titled: Does your doctor wash his hands?

The gist of it is that an internal audit of doctors in Singapore General Hospital showed that half the doctors at Singapore General Hospital (SGH) don’t wash their hands between patients. Ew. It doesn’t come as much of a surprise to J.

Doctors vary in their attention to infection control. Surgeons are fantastic are infection control in the operating theatre, but not in the wards. Infectious diseases physicians are naturally the most enlightened, eschewing labcoats, ties and long sleeves in favour of consistent handwashing. One SGH ID physician wears a badge around that says, “Ask me if I’ve washed my hands.” Even in medical school, you can tell the difference between folks’ meticulousness in infection control. Furthermore, it’s probably not an ID physician that instituted the policy in SGH that medical students must wear ties at all times.

J. is pretty obsessive about cleaning hands. Unfortunately to the extent that when watching Operation Theatre II, he cringed at the touching group hug scene because the play had said “the plague is spread by the slightest skin contact”.

Anyway, that said, J. just thought he’d point out something missing in the newspapers: alcohol/chlorhexidine handrub is a good alternative to handwashing. So if your doctor decides to use an alcohol handrub after examining you, don’t think that it’s a lackadaisical attempt at cleaning his hands. It can be superior in many instances.

It’s been shown to help decrease nosocomial infections (Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub.)

Contrary to popular belief, alcohol handrubs actually reduce hand bacterial load more than handwashing. It’s faster and more convenient in Singapore hospitals (one alcohol handrub at every bed). Really, the only times you should expect your doctor to wash his hands on the ward round instead of alcohol handrubs should be:

  • When hands are visibly soiled (e.g. after examing sacral sores in a pamper-clad patient)
  • After using powdered gloves
  • After touching anything near a patien known or presumed to have Clostridium difficile – alcohol hand rubs might not be as effective against spore-forming organisms

It’s not just the hands, too. There are quite a few conscientious physicians, like the ones J. has followed in ID or renal medicine. They’ll wipe down their stethoscopes with alcohol swipes after each patient (unless said stethoscope was not used), use disposable cotton wool/toothpicks/swab sticks for neurological examination, so on and so forth.

Anyway, here’s a quick reminder about alcohol-based hand rubs. The hands should not be visibly soiled. An adequate quantity of hand rub should be squeezed from the bottle, it should cover all aspects of the hands (much like rubbing soap when handwashing) and crucially, hands must be allowed to dry. Got it? Good. Less nosocomial infections = less work.

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