Maybe you've seen a sign around a hospital that reads something like this: "Hand washing is the single most important way to prevent infection. Did your health care provider wash their hands?"

Here's the way I interpret that message: "We can't get our doctors, nurses, technicians and other health care providers to wash their hands. The failure of providers to wash their hands has been a well-documented disgrace for many decades. So we're going to put the burden on the patient." But what a feeble failure this will prove to be.

Exactly what is the patient supposed to do? Can't you hear the patient asking, "Dr. Jones, did you wash your hands?" Chances are he will answer, "Yes." Then what are you supposed to do if you suspect he hasn't or want reassurance that he has?

For starters, the sign ought to be changed to at least make it clear beyond doubt what is expected: "Did your health care provider wash his hands IN FRONT OF YOU? He is required to do so. If he doesn't, ask him to do so." The hospital should have a rule that providers must wash their hands in front of the patient before patient contact.

Then, all nurses and others ought to be instructed to require anyone who comes in to touch a patient to say, "Please wash your hands in front of the patient."

This has become much easier with the advent of the alcohol wash, a method of washing your hands that is the equivalent of washing hands the old way, with soap and water (except in cases where there is heavy dirt or debris on the hands, in which case stay with soap and water). These alcohol-wash dispensers can be placed on any hall, on any table or anywhere else to make them easily accessible in the patient's view. They can even be placed in the health care provider's pocket.

I'm not sure that will work, but if it doesn't, then other approaches should be tried until our great health care providers learn what any kindergartner knows - wash your hands when you're supposed to.

I recently had a fat laugh when I saw major grants made to various health care centers to study methods of preventing hospital-acquired infections. Before I'd grant any money for some fancy study in some specialized context, I'd demand proof that the medical center has figured out ways to make health care providers wash their hands when they're supposed to. They ought to learn to walk the walk of infection control before they try running, driving or flying.

This has been an urgent priority since 1847, when the great Hungarian physician Ignaz Semmelweis discovered that lives would be saved if doctors stopped going from cutting up cadavers to delivering babies, without bothering to wash their hands or change their gowns in between. The failure of the medical profession to resolve the hand washing problem displays ignorance beyond belief, as they were still going from cadavers to delivering babies without washing their hands in between.

In the process, they're killing an estimated 103,000 Americans every year, not to mention all the illness, suffering and costs they're causing. When will the medical profession wake up and do something?

A crusader for hand washing, Betsy McCaughey, a former lieutenant governor of New York, reports that health care providers abroad are beginning to wake up to reality. She writes how Denmark, Finland and the Netherlands have brought under control a specific kind of deadly antibiotic germ "[t]hrough the rigorous enforcement of rules on hand washing, the meticulous cleaning of rooms and hospital equipment, the use of gowns and disposable aprons to prevent doctors and nurses from spreading germs on clothing and the testing of incoming patients to identify and isolate those carrying the germs."

If that's not bad enough, the problem of hospital infections is getting worse all the time due to the growing danger of antibiotic resistant germs. But hospitals seem more concerned with the sensitivities of doctors and other health care providers so they avoid tough rules and rigorous enforcement and instead slaughter and sicken patients by the hundreds of thousands. Just a thought.

If health care providers ignore the key technique of preventing hospital infections (hand washing), what makes you think they're doing any better in the dozens of other areas that are more complicated?

Herb Denenberg, a former Pennsylvania insurance commissioner and professor at the Wharton School, is a longtime Philadelphia journalist and consumer advocate. His column appears daily in The Evening Bulletin. You can reach him at

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