Clean your hands! And wash your stethoscope while you’re at it.

It’s now been some years since I’ve felt comfortable working with the feel of soft cotton on my elbows. Even when not in a designated clinical zone, its sort of wrong. Anyway, after the success of ‘wash your hands’ decade in making millions of people have cracked, sore skin, there’s a thrust to the obsessive wiping of stethoscopes too.

But how ‘evidence based’ is this new hygienic puritanism?

There are people investigating the case for even greater quantities of cleansing products in the wastebins of our hospitals, but in the meantime, do you have an opinon?

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  • I think that this is a tough one to base on pure evidence, Bob.

    If I'd told you, five years ago, that we'd have reduced the levels of MRSA to the very low levels we see now by being bare below the elbows in the NHS, you'd have laughed, and would have been as wrong as I was when I laughed at putting paracetamol in blister packs to reduce overdose.

    The problem is, you've got two things entangled:
    1. There is the fact of actually cleaning your hands and reducing carriage.
    2. There is the social signalling of the set of behaviours that you are modelling. And I think it's this which is the most important.

    Here's a minor experiment. If you're a senior doctor, as you're walking down the ward with whatever grand following your status affords you, sterilise your hands as you pass an alcogel. Then count how many other people follow your lead. You'll be surprised.
    If you're a non-senior doctor, you can do something else. Bustle ahead of the consultant on the round, and do exactly the same. You have now signalled a behaviour – and you'll be surprised at how easily it is transmitted even to the more senior members of the team. Try it with a manager; that's fun too.

    Transmission of the behaviour seems to be greater, I think, if you reinforce the visual with a statement: “I'm just sterilising my hands” (caveat for actual efficacy of the actual wash as above).

    So, does the person by person effect of being bare below the elbows improve hygiene? Hard to tell. Does the cumulative effect of keeping the whole world focused on improved hygiene have an impact? Look at the figures…

  •… supports what you've said, Bob, though it's a pity they didn't control for hand hygiene between the two groups. And I get the whole “social signalling” argument too, but I wonder whether the Millennium Generation just use it as an excuse to be scruffy? Why do surgeons mostly seem to retain tie and suit? What impact does that have on children and parents?