Cleaner Hands, Fewer Infections? Maybe Not

Corrected on 1/24/08: An earlier version of this blog misspelled Mark Rupp's name.

If only those doctors and nurses would wash their hands...

Hand washing is one of those perpetual skeletons in medicine's closet. Infections acquired in U.S. hospitals kill an estimated 100,000 patients annually—yet only about 40 percent of doctors, nurses, and other hospital caregivers clean their hands before touching patients. It's not as if hospitals aren't trying. Posters are displayed. Briefings are conducted. Dispensers of germicidal hand gels have sprouted on walls outside (often inside) patient rooms so caregivers don't have to scrub at a sink (to be rewarded at the end of the day with chapped hands). Don't they get it? That clean hands would lower the rate of infection and lead to fewer deaths?

Or so it would seem—but not according to a two-year investigation at the University of Nebraska Medical Center. A study in the January issue of Infection Control and Hospital Epidemiology found that even after doctors, nurses, and other caregivers in two of the hospital's intensive-care units almost doubled their use of hand sanitizers, from about 38 percent to nearly 70 percent, infection rates didn't budge.

"There's a cautionary tale here," Mark Rupp, lead researcher and professor of infectious diseases at the medical center, told me. "Everybody takes a very simplistic view of the infection-control problem in our hospitals. It's like, gosh, all you have to do is wash your hands, and the infection problem will go away. But there's more to infection control than hand washing." Rupp was among those surprised. "I thought we would find some sort of signal in the direction of improvement," he said.

Among the possible reasons for the study's findings, said Rupp, is that the hospital's infection incidence was low at the start of the study, so no one factor could move the number dramatically. Another is that 80 or 90 percent compliance might be necessary to keep bacteria from being transmitted. Hand washing, he concludes, is only part of the equation—one element in a package that wraps in other elements, such as meticulous care of IVs and urinary catheters and thorough room cleaning.