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This is a great article by Martine Ehrenclou which points out that while it’s uncomfortable to raise this concern with your doctor, it’s critical to speak up.

Having just seen my primary care physician yesterday for an overdue check-up, I realized after the appointment was over that I had not wrestled with the idea of asking him if he had washed his hands before examining me.

I completely forgot. Maybe on purpose.

It’s difficult to ask your doctor or other medical provider if he/she has washed up. Some physicians see it as a direct challenge and take offense, while others are receptive to respectful prompting.

According to FierceHealthcare’s article, Patient’s Reluctance to Tell Providers to Wash Hands,  I’m not the only patient who is reticent to bring up the hand hygiene subject with my medical providers. FierceHealthcare reports that over half of patients won’t ask their doctors to wash their hands. And we all know that health care workers’ hands are the most common vehicle for transmission of healthcare associated infections. The NIH says it plain and simple: hand hygiene is the leading measure to reduce healthcare associated infections.

To make things even more complicated, research in the Archives of Internal Medicine reports that 27 percent of clinicians say it’s not a patient’s place to instruct them to wash their hands.

Whose place is it?

According to The Joint Commission, 1.4 million people worldwide are suffering from hospital-acquired infections. In the U.S. one in every 136 patients becomes severely ill as a result of acquiring an infection in a hospital. It is estimated that each year more than 99,000 die because of hospital-acquired infections.

That’s nothing to sneeze at.

Healthcare associated infections don’t just occur in hospitals. More medical treatment has shifted to outpatient settings and fewer patients are being admitted to hospitals. That means more healthcare associated infections occur outside of the hospital setting.

Both patients and medical providers understand the importance of good hand hygiene to prevent the spread of healthcare associated infections. No one wants to contract or spread MRSA, C.diff, or other infections. However, Johns Hopkins Center for Innovation in Quality Patient Care reports that healthcare providers adhere to national guidelines for hand hygiene less than 50 percent of the time.

That puts patients in a difficult position.

If healthcare providers in the U.S. are compliant with good hand hygiene protocols less than half the time, and over 50 percent of patients won’t speak up to medical providers about washing their hands, and a good percentage of those medical providers are not open to patients’ requests for hand washing, we have a problem. What can patients do?

Doug Hall of PULSE of Florida suggested a large name-tag or clip-on badge with the reminder, “Wash Hands Before Patient Contact.” That’s a valuable idea for hospitalized patients, but I can’t imagine walking into my PCP’s office with that badge clipped onto my blouse.

Once, I asked a pediatrician who was subbing for my daughter’s pediatrician to wash her hands before touching my child. I’d watched her interact with two sick kids in the exam room across from us. Those kids were coughing, wiping their noses, rubbing their hands on their pants, and climbing all over the exam room table and chair. I pitied the poor parent and child who were next in line for that room. Without washing her hands, that pediatrician walked directly into our exam room and headed for my daughter. I asked her to wash her hands first. It was uncomfortable for both of us but worth it. Somehow it was much easier advocating for my daughter than for myself.

I think we need to change our attitudes about how we interact with our medical providers. If you look at some of the statistics I quoted about how many people get infected by health care associated infections (a polite way of saying ‘diseases spread because people are not using good hand hygiene’) the reality is pretty shocking and scary. Maybe we need to think about the number of people we all know who have been affected by one of these infections, how someone we know or love developed C.diff and had a terrible time getting rid of it. Or died.

If we work with our medical providers, and regard them as partners instead of demi-gods, maybe it will be easier to ask them to wash their hands, use hand sanitizer and don disposable gloves. Maybe we can develop enough self-confidence as patients to speak up and politely say, “Would you please wash your hands?

And maybe it’s time for medical providers to partner with patients and resist regarding us as being on the other side of the fence. Patient safety is a team effort.

For more information on The Take-Charge Patient: How You Can Get the Best Medical Care, go to www.thetakechargepatient.com

For more information on Critical Conditions: The Essential Hospital Guide To Get Your Loved One Out Alive, go to www.criticalconditions.com

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