Thursday, September 16, 2010

Hands -- Guidance and Germs

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

Some interesting items this week involving hands.  The one which has gotten much news coverage is the issue of hand washing.  Take a look at some of the headlines:
High five! Hand washing on rise (Chicago Sun-Times)
For Many, 'Washroom' Seems to Be Just a Name (New York Times)
93% of women wash their hands vs. 77% of men (USA Today)
All the above are reporting on the same study, but the difference in presentation is amazing to me.

The above study doesn’t involve hand washing in a hospital or doctor’s office setting.  The JAMA article (2nd reference below) does, but this article focuses on whether public reporting of hand washing compliance is helpful or not.  Do we inflate our numbers to make ourselves look better?
Public reporting creates an incentive to maximize performance but does not specify the manner in which this is achieved. Broadly speaking, 2 approaches are possible. Hospitals can adopt evidence-based strategies designed to improve patient outcomes that will also improve the publicly reportable indicator, or they can adopt indicator-based strategies designed to improve the reported indicator that may not improve outcomes and may even cause harm. Evidence-based improvement strategies would be favored in an environment in which organizations focus on improving patient outcomes—when such strategies exist and are easy to implement. Conversely, indicator-based improvement strategies would be favored in an environment in which the hospital focuses on protecting its reputation, when evidence-based improvement strategies are unproven or resource intensive, or when measurement of the indicator is easily manipulated to show improvement. …

I wish copyright laws would allow me to reproduce the entire essay from a recent issue of JAMA (first reference below).  The essay is written by Ariela Zenilman about her father’s hands. 
Between the scrapes from paper cuts, the finger on which a ring is worn, and the color of nail polish, the hands of the human body tell a story. They are the most mysterious reflection of character. The hands ….. Surgeons are blessed with steady hands for a reason: they reduce the trembling in the hands of worried family members, counteract pain and destruction, and alter creation for the better by fixing fault and disease within the body. A surgeon has the remarkable gift of a set of multifunctional and dexterous hands.
I have always admired my father's hands. From a very early age I could tell his grace and dedication to detail were apparent in how he moved and touched, felt and experienced the world around him. …... His hands seemed inexplicably and effortlessly linked to his every thought: as a young child I always dreamed of having hands like his.…….
When I see my father's hands ……. His hands are a mere reflection of his heart, an attribute I hope to see in my hands as I follow in his footsteps.
…. Hands reflect ability, accomplishment, and passion. …………., I have learned to trust my instincts, follow my heart, and, most of all, not to underestimate the power of my own hands.

I love hands.  I have been in love with the anatomy and mechanics of hands since medical school.  Before then I just loved to watch them work (my mother making biscuits, my teacher’s writing, basketball players shooting baskets, pianists, etc). 
For the general public, wash your hands – flu season is upon us.
For us involved in patient care, wash your hands before and after each patient.  This is one (if not the best) of the best lines of defense in preventing the spread of infection.

The Hands That Guide Me; Ariela Zenilman; JAMA. 2010;304(10):1049. doi:10.1001/jama.2010.1291
Public Reporting of Hospital Hand Hygiene Compliance—Helpful or Harmful?; Matthew P. Muller; Allan S. Detsky; JAMA. 2010;304(10):1116-1117.
Finger and Wrist Exercises (April 19, 2010)

1 comment:

rlbates said...

I am so very sorry, Dr Bailey for accidently deleting your comment when I meant to hit approve. I have copied and pasted it here. Please, visit her blog at OTB Skin Care (

I'm all for hand washing; it helps cut down on the spread of both germs and greasy fingerprints on surfaces.

Along with good hand hygiene comes a need for good hand skin care to prevent irritant hand dermatitis. I summarized my hand care advice in a post last flu season when I started seeing an epidemic of hand sanitizer induced hand dermatitis on patients concerned with avoiding the swine flu.

Good hand care is an essential part of hand washing and hand sanitizer use. Anyone interested can find my dermatologic advice by typing 'Hand Sanitizer' into the search box on my blog. I think I'll refresh the content this week, thanks for the prompt.

Cynthia Bailey MD, Dermatologist