2 Out of 3 Medical Students Don't Know When to Wash Their Hands

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It's cold and flu season, which means you should be washing your hands — a lot. And that rule should apply to health care workers most of all, to protect not just themselves but their patients. Problem is, most doctors are confused about when they're supposed to hit the sink, a new study of medical students finds.

Researchers at Hannover Medical School in Germany surveyed 85 medical students who were about to enter their clinical training — when they deal with actual patients. The surveys were administered as part of a lecture class that students must pass before initiating patient contact.

The doctors-to-be were given seven scenarios, five of which required hand-washing: before contact with patients, before preparing IV fluids, after removing gloves, after contacting patients' beds and after contact with vomit. (The other two scenarios did not require hand-washing.)

Only 1 in 5 students correctly identified what to do in all seven situations. And just 1 in 3 got all five hand-washing scenarios correct. Most students knew that they were supposed to wash their hands before contacting a patient, after touching their bed and after contacting vomit, but 15% to 20% could not correctly identify the other two hand-washing situations. (Last month, a study found that wearing gloves made health care workers less likely to wash their hands, which is dismaying since germs can travel through latex gloves.)

From the results, published in the American Journal of Infection Control, it's clear that doctors-in-training need more education about the importance of hand-washing, and more specifically, practical lessons on when to use either hand sanitizers or the sink. Previous studies have suggested that health care workers are confused about the protocol: a 2006 British survey found that 58% of medical students didn't know when to use the alcohol-based hand sanitizers.

So how can health care workers improve on their hand-washing compliance? This is a source of constant concern and study in hospitals. One thing that helps is to remind them that it's not only their own health, but also the health of their patients that's at stake. So, the next time you're in the hospital or at the doctor's office, and your physician doesn't wash his hands before beginning an exam, you might want to point him toward the sink.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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Rare transplant gives quadruple amputee two new hands

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1 of 4. Doctors perform a double-hand transplant at Boston's Brigham and Women's Hospital Plastic Surgery Transplantation Program last week, in a photo released to Reuters on October 14, 2011.

Credit: Reuters/Brigham and Women's Hospital

By Lauren Keiper

BOSTON | Fri Oct 14, 2011 2:44pm EDT

BOSTON (Reuters) - A 65-year-old quadruple amputee has received two new hands in a rare double transplant operation, Boston's Brigham and Women's Hospital said on Friday.

Richard Mangino got the two hands last week in a 12-hour transplant procedure by a team of more than 40 doctors, nurses and other medical staff, the hospital said.

Mangino said he's adjusting to the new hands gradually and said now he won't have to "perform a miracle" every day to do simple things like make coffee and get dressed.

Speaking at a news conference seated in a wheel chair with his arms and hands propped on stack of pillows, Mangino said he prayed for the ability to touch his grandsons' faces, stroke their hair and teach them to throw a ball

Mangino, from Revere, Massachusetts, lost his arms below the elbows and legs below the knees after contracting sepsis, a bloodstream infection, in 2002.

The complicated surgery included transplanting skin, tendons, muscles, ligaments, bones and blood vessels on both forearms and hands, the hospital said.

Doctors said Mangino independently moved fingers just days after surgery and called the results a "resounding success."

His recovery will take many months and doctors expect him to regain sense of touch in six to nine months with ongoing therapy to help him learn to grasp and pick things up.

The double-hand transplant is the second performed by Brigham and Women's, a teaching affiliate of Harvard Medical School.

In May, a team performed a full face transplant and its first double-hand transplant on Charla Nash, a Connecticut woman who was mauled by a chimpanzee in 2009.

The hospital said the hand transplant was successful, but the hands did not thrive after complications from pneumonia and were removed.

There are a few other programs around the country that perform hand transplants.

The first hand transplant was performed in France in 1998, and the first in the United States was completed a year later.

Doctors said about a dozen hand transplants have been done in the U.S. and believe just four of those have been bilateral.

(Editing by Ellen Wulfhorst and Jerry Norton)

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Now wash your hands - and your mobile

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14 October 2011 Last updated at 00:55 GMT Often not as clean as it looks... It is the sort of news story that will have left many feeling queasy over their breakfast cereal - a study which suggests one in six mobile phones is contaminated with faecal matter.

Researchers at the London School of Hygiene and Tropical Medicine and Queen Mary, University of London took nearly 400 samples from mobile phones and hands in 12 British cities.

They found 16% of phones and 16% of hands harboured E. coli (Escherichia coli), bacteria which inhabit the human intestines.

The largest proportion of contaminated phones was in Birmingham (41%) while Londoners were caught with the highest proportion of E. coli present on hands (28%).

Why do so many people clearly not wash their hands with soap after a visit to the toilet? Perhaps they do, but are simply doing it wrong.”

End Quote Fergus Walsh

But the sample size in each city was small, so the variations between them could be a statistical anomaly.

However Dr Val Curtis, from the London School of Hygiene says the study showed clear differences between north and south.

"We found the further north we went the more hands and phones were likely to be contaminated. It could be the bugs survive better in colder and wetter conditions or it might be that people wash their hands less."

I explained to Dr Curtis that such comments were unlikely to win her friends in Glasgow and Liverpool - two of the cities where samples were taken.

But she brushed this aside explaining that after a similar survey three years ago she was advised not to hang around Newcastle.

Dr Ron Cutler of Queen Mary, University of London, explains the findings

Archers warning

Most strains of E. coli found on the hands and phones are not likely to cause major ill-health, although listeners of "The Archers" will know that Clarrie Grundy became an unwitting carrier of the bacteria, leading to a number of children being hospitalised in the fictional county of Borsetshire.

Dr Curtis explained that they were using E. coli as a marker for the presence of faecal matter.

She said: "Campylobacter and Salmonella bacteria are much more likely to cause a gastric infection and could easily be passed on through faecal contamination."

So we are talking about poo, excrement - on mobile phones and fingers.

Hand washing technique

Why do so many people clearly not wash their hands with soap after a visit to the toilet? Perhaps they do, but are simply doing it wrong.

I remember having correct hand-washing technique described to me by the virologist Professor John Oxford.

He thought people didn't wash thoroughly enough, or long enough - two verses of Happy Birthday to you were suggested.

Perhaps there is also a confusion in some people's minds about dirt and germs. After all, there is plenty of research suggesting dirt can be good for you.

Since the late 1980s the "hygiene hypothesis" has argued that the lack of early childhood exposure to some germs may be linked to the rise in allergic diseases, by suppressing the development of the immune system. It's a much-debated theory.

But while letting your children - or your husband - play in the dirt may well be ok, they still need to wash their hands after the toilet. Or after handling raw meat and poultry.

Big killer

You simply have to look to the developing world to see the devastating effects of poor hygiene. Diarrhoeal disease remains one of the world's biggest killers.

While hand-washing may help prevent a nasty stomach bug here, in poorer countries it can save lives.

The survey from the London School of Hygiene and Tropical Medicine is timed to publicise Global Handwashing Day on 15 October.

It is an annual event which promotes hand-hygiene, the cheapest and most effective way of preventing infection by bacteria and viruses.

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