Quick takes on three recent stories

Handwashing

The magazine Popular Science reported on a paper which found after 20 subjects washed their hands at water temperatures of 100, 80, and 60 degrees, the temperature had no impact on bacterial counts. They also found antibacterial soap was no better than plain soap and water.

What did matter was time—10 to 20 seconds of lathering was better than 5 seconds, and 40 seconds was no better than 10 or 20.

The authors concluded that hands should be washed in water that was most comfortable for the individual.

In a blog post from last year, I pointed out that washing hands for more than 40 seconds, as advocated by a paper in Infection Control and Hospital Epidemiology, was impractical due to the excessive amount of time busy hospital staff would need to invest in doing so multiple times per day.

For example, 10 washes per hour at 40 seconds per wash is almost 7 minutes of hand washing times 8 hours equals 56 minutes.

Drivers who follow other drivers

The journal Frontiers in Psychology published a paper called “I’ll Show You the Way: Risky Driver Behavior When ‘Following a Friend.’” The authors, from the Human Systems Engineering department of Arizona State University, found that in order to keep up with the lead driver, drivers who don’t know the way took more chances when they followed someone.

The work was done by testing 16 college student subjects on a simulator. Drivers who followed were more likely to drive significantly faster, change lanes quicker, and in general “engage in riskier behaviors” than when listening to audible directions from a simulated GPS system.

The authors recommended that following another driver to a destination not be done. However if following is necessary, the driver of the lead vehicle should go slower and anticipate what the following driver might have to do to keep up.

1) I think most of us could have predicted the outcome of this research and come up with the same recommendations. 2) Does anyone who drives a car not own a smartphone in 2017?

What not to do with a hotel room tea kettle

According to the Metro.co.uk website, this is a thing that some people in China do when staying in a hotel. Whether travelers in Western nations also do so is not known.

A reporter for Gizmodo Australia asked a molecular biology professor from New Zealand’s Massey University to comment. She said, “It is super super super super gross” and pointed out that boiling does not necessarily kill spores formed by some types of bacteria.

Even if boiling killed all known living things, I still wouldn’t want to drink a cup of tea from a kettle that had contained someone’s skivvies the night before.

Hand hygiene follow-up: The CDC may be reading my posts

Two weeks ago I blogged about a hand hygiene study that showed a 6-step alcohol-based hand washing technique significantly reduced hand colony counts compared to a standard 3-step technique.

The 6-step process took about 45 seconds and when coupled with the amount of time a healthcare worker took to remove gloves, go to the dispenser, and let the hands dry, at least a minute will have elapsed.

In a busy emergency department with 10 or more hand hygiene events per hour, personnel might spend 80 to 120 minutes per shift on that activity alone.

Today is World Hand Hygiene Day and none other than the Centers for Disease Control has validated my hypothesis. Here is what the CDC tweeted today:

An anonymous commenter on my original post said, "Now imagine doing this [the 6-step technique] on rounds, with 40 patients to be seen, and a chief, pgy 3, and 2 interns who have to line up at the sink to do this."

Here’s a problem with that new 6-step hand hygiene study

A 6-step alcohol-based hand hygiene technique is significantly superior to the standard 3-step technique in reducing bacteria colony counts.

So says a randomized trial with 78 nurse and 42 doctor participants recently published online in the journal Infection Control and Hospital Epidemiology. The full text of the study is available here.

At 42.5 seconds, the 6-step process took significantly longer than the 35 second 3-step.

Multiple media outlets, including the New York Times, published stories about this study.

The study was done properly. But after reading it, I had an issue.

That electric hand dryer study was bogus: Here's why

Just about everyone I follow on Twitter commented and/or linked to an article about a study claiming that electric hand dryers spew bacteria all over people using restrooms.

The paper, which appeared online in The Journal of Hospital Infection, said that airborne germ counts near jet air dryers were 27 times higher than counts near paper towel dispensers, and counts near warm air dryers were 4.5 times higher. The authors also coated subjects hands with black paint and measured spatter patterns on surrounding walls and persons dressed in disposable coveralls. And a photo from the study shows the dispersal pattern from a warm air dryer.

So case closed—paper towels are better, right?

I'm not so sure. Instead of reading an article about the paper or just the abstract, I obtained a copy of the whole paper. I also found some comments about it from a spokesperson for a hand dryer manufacturer.

What are the flaws in the study?

Hospital installs hand washing surveillance cameras

Doctors and nurses in the ICU at Long Island’s North Shore University Hospital are being watched by 39 video cameras in an effort to increase compliance with hand washing. According to a report hand washing compliance is up from less than 10% to 90% since the program started.

Cameras are positioned near the doors of patient rooms and at sinks Patients are not being videoed. The real-time feed is observed by workers in India. Staff failure to wash hands is noted, and the results are posted on electronic bulletin boards in the unit. So far, miscreants are simply talked to.

"No one's been fired, no one’s been written up but there have been one-on-ones," the news story says and, “Infections have decreased though an exact percentage was unavailable.” That raises the question of how they would know if infections have really decreased if the exact percentage is unavailable. And there’s another question, “Is the decrease statistically significant?”

This venture, while well-intended, seems like a bad idea to me. I suppose you are thinking, “Could Skeptical Scalpel really be against hand washing?” Well, I’m not. But what seems logical and correct sometimes may not be. For example, everyone knows that sinks with faucets that have electronic eye sensors are cleaner and better to use in hospitals than sinks with manual faucets, right?

A study presented at a meeting of the Society for Healthcare Epidemiology of America last year by a group from Johns Hopkins concluded the following: Electronic faucets were more likely to become contaminated with Legionella spp. (species) and other bacteria after water system disruption. Electronic faucets were less likely to be disinfected after chlorine dioxide remediation. Electronic faucet components may provide points of concentrated bacterial growth. These findings led to removal of all electronic faucets from clinical areas in our institution. [Emphasis added.]

Washing hands with soap and water may cause dryness and irritation resulting in skin breakdown. It may be that constant, obsessive hand washing and use of gels could promote the emergence of resistant organisms.

Another potential issue with the video observation is a false accusation of failure to wash. Patient rooms and patients themselves are not being watched. Let’s say a nurse went into a patient’s room to tell him something and didn’t touch anything. A person in India watching a video from a camera focused on a door or sink would not be able to tell that. If the nurse doesn’t wash her hands when she leaves the room, is she going to be cross-examined?

And what about cost? How much does it cost to install and maintain 39 video cameras, stream the video to India and pay people there to watch the monitors and feed back the information 24 hours per day? Remember, they have no proof that video surveillance reduces infections.

What does this scheme say about the relationship of the professional staff to the hospital’s administration? More problematic is the fact that even though they know they should, doctors and nurses at a major medical center apparently cannot be trusted to wash their hands unless they are spied upon. What else do they not do?

Instead of issuing press releases about this ill-advised program, hospital management might want to consider investigating why their staff is non-compliant.