Handwashing: simple, but effective

Using ward rounds in the department of surgery at a major teaching hospital, and with the help of the preregistration house officers (PRHO), we assessed whether the lesson taught to us by Semmelweis had been forgotten. We asked the PHROs to count the number of patients examined by their consultant or registrar on a ward round, together with the number of wounds examined, and the number of times they washed their hands between patients. Over a 2-week period, following seven consultants and four registrars, 26 ward rounds were followed. Of 239 patient events, which are defined as a clinician reviewing a patient in order to assess their treatment, a total of 88 involved an examination (37%) and, of these, 41 had postoperative wounds (47%). The number of times clinicians washed their hands between examinations was 36 (41%). Between the two groups of clinicians, the consultants washed their hands 30 times in 55 examinations (55%), while the registrars washed their hands six times in 23 examinations (26%). When Semmelweis died in 1865 his beliefs were still largely ignored by clinicians. It would seem from our results that in both senior and junior staff the simple exercise of handwashing is not practised de rigor. For the safety of the patient and the clinician we recommend a more fastidious adoption of the handwashing practice.