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Every doctor I know showers before work. But our collective scorecard for hand washing leaves much to be desired. Study after study has sadly shown that healthcare workers across specialties, don't wash their hands often enough.

The importance of handwashing as a means to protect patients from illness was established by Dr. Lister back in the 1800’s. At that time seeing your doctor could be a death sentence when they laid their hands on you - like a perverse version of King Midas' touch that instead of turning all to gold, turns things putrid. The cause was a transfer of germs from their hands, deadly pestilence that doctors are immune to (not all the time), because of our daily flirtation with them, that can wreak havoc on susceptible patients.

So why don't Doctors wash their hands enough?

One reason doctors, myself included, don't take handwashing serious enough, is that the problem is invisible. If I get your blood on my hand I see it and run to wash my hands. But if I pick up MRSA (a drug resistant bacteria) from touching your pimple, I don't get an optical cue to prompt me to the sink. Add choking time constraints and you can see doctors skipping the soap.

The next reason is that of attribution. If I transfer strep from my last patient to your mouth there is no immediate tell. Your throat doesn't puff and explode with white colonies like a petri dish until sometime later. By that time likely neither of us puts the pieces together and are none the wiser. I continue on self-righteously thinking that I'm making a difference healing people, unaware I may also be harming some.

Lastly, in some cases I've seen doctors resistant to frequent hand washing because of the toll it places on their own skin. I have semi-permanent palmar furrows and lapideous patches from over hygiene earlier in my career. Sanitary dispensers are a satisfactory solution to the quandary of hand washing. These gels or foams take about a New York second to squirt and rub into your hands and may even have an additional advantage by providing a protective layer against pestilence until rubbed away. They have become my favorite method of keeping my hands, not clean, but sterile. It's way faster. And just as effective. But it too can lead to angry dermatitis.

What's being done to get Doctors to wash their hands?

Many health authorities have begun initiatives to prod their doctors to wash or sanitize their hands more, and when it comes to surgical procedures, compliance is almost universal - surgeons all 'scrub' before cutting and don sterilized garments called 'scrubs' (it's mandatory and scrutinized). But it's in clinics and hospital floors where monitoring and accountability are not feasible that we falter. Posters by sinks are a passive tool which I find ineffective - after a while the poster become part of the wallpaper out of conscious awareness. Placing antiseptic dispensers en route to patients along desire paths I find works better - it jolts my memory just before patient contact and is convenient. But one of the best prompts that I've found is seeing my patients using the dispensers themselves or seeing my colleagues do so: monkey see, monkey do.

Alas, I hope you won't hold this article against me should I extend you a handshake. But remember, caveat emptor; you never know where those hands have been... ;)

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