Health Experts Don't Always Sanitize Their Hands, Data Show
DAVID GREENE, HOST:
For years now, public health experts have been giving us some pretty simple, cheap, effective advice. To keep yourself healthy, wash your hands. Well, now there's some new research into how good doctors, nurses and other health professionals are at following their own advice. To talk about this, we've brought in NPR social science correspondent Shankar Vedantam, who joins us regularly on the program. Hey, Shankar.
SHANKAR VEDANTAM, BYLINE: Hi, David.
GREENE: So I'm scared to ask about this.
GREENE: Doctors and other health professionals, are they not good at following this advice?
VEDANTAM: You know, from what I know anecdotally of doctors, I would say they do very well. But the data actually point in the other direction. So most doctors and nurses will tell you that hand-washing is highly effective, and guidelines actually tell doctors and other caregivers to sanitize their hands before and after they have contact with patients. But it turns out that fewer than half of all caregivers remember to follow this advice at all times.
GREENE: And this is really troubling because, I mean, doctors and nurses are coming into constant contact with people who are sick.
VEDANTAM: Exactly, and we've known for a very long time, David, that infections that are spread in medical settings have really serious costs, both in terms of patient lives as well as in terms of dollars. There's some new research now that documents another aspect of this problem. I spoke with Katherine Milkman at the Wharton School at the University of Pennsylvania. And along with her co-authors, Hengchen Dai, Dave Hofmann and Brad Staats, she analyzed data from 37 hospitals across the United States.
KATHERINE MILKMAN: One of the main and most interesting things we found is that over the course of a single work shift - so for a caregiver this is something like a 12-hour workday - at most, we see a dramatic decline in compliance. So from the beginning to the end of a work shift, the rate at which caregivers are sanitizing their hands drops really precipitously by about 8 percentage points.
GREENE: All right. So it sounds like fatigue might be involved here. But before we get to that, I just want to understand how this study took place. Were researchers following around doctors and taking note on a clipboard or something?
VEDANTAM: Not quite, David. So the data comes from a company called Proventix, which outfitted more than 4,000 caregivers with electronic badges. Now, the badges tracked the caregivers as they go in and out of patient rooms, and they also track whether the caregivers activate a hand sanitizer as they enter and as they leave the room. Now, it's possible that some of the doctors and nurses are using other ways to sanitize their hands, but Milkman's numbers are consistent with earlier studies that show how often caregivers sanitize their hands after patient contact. The size of the study also gives us confidence that what we're seeing is accurate. Milkman ended up with more than 14 million instances where a caregiver had contact with a patient and should've washed his or her hands after that contact.
GREENE: Well, a huge study. OK. Well, let's get to what might be causing this. Long shifts, less sanitizing - is it fatigue?
VEDANTAM: Fatigue clearly seems to be playing a role. One of the things that Milkman finds is that when caregivers come back from a break, hand sanitizing rates shoot up. But it could also be other things, David. Maybe your skin feels sore after you've sanitized your hands 25 times in a single day. Whatever the cause, Milkman says it has really big consequences, and in fact, David, you're going to find numbers that she cites really startling.
MILKMAN: The 8 percentage point decline we're seeing over the course of a single workday could actually account for thousands of patient lives and billions of dollars of spending that's unnecessary if we could simply eliminate that decline.
VEDANTAM: You know, and whatever the numbers are, David, no doctor or nurse will tell you that sanitizing your hands is a bad idea. These guidelines are not remotely controversial.
GREENE: But if billions of dollars are at stake and actual lives because infections might be spread in ways they shouldn't be - I mean, is it just a matter of stressing numbers like this to doctors and nurses so they really get the importance?
VEDANTAM: Yeah, I think awareness might be the first step. Hospitals can also do other things to minimize fatigue among caregivers. And maybe these badges that measure whether you've used the hand sanitizer, maybe they can send off a little alarm every time you have patient contact and you've forgotten to use the hand sanitizer.
GREENE: All right. Interesting stuff as always. Shankar, thanks a lot.
VEDANTAM: Thank you, David.
GREENE: That's Shankar Vedantam, who regularly joins us to talk about social science research. You can follow him on Twitter @HiddenBrain. You can follow this program @MorningEdition. The program is MORNING EDITION from NPR News. I'm David Greene.
RENEE MONTAGNE, HOST:
And I am Renee Montagne.
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