Physician, Disinfect Thyself

We spend a good bit of time in SuperFreakonomics writing about doctors’ hand hygiene: specifically, how important good hand hygiene is in order to cut down on hospital-acquired infections and yet how historically it has proven difficult to enforce. That’s because behavior change can be hard in general, but particularly so when it doesn’t necessarily benefit the people who are actually changing their behavior.

So it turns out that some of the most effective means of discouraging infections don’t rely so much on behavior change; as we write:

Among the best solutions: using disposable blood-pressure cuffs on incoming patients; infusing hospital equipment with silver ion particles to create an antimicrobial shield; and forbidding doctors to wear neckties because, as the U.K. Department of Health has noted, they “are rarely laundered,” “perform no beneficial function in patient care,” and “have been shown to be colonized by pathogens.”

If this topic interests you, then you certainly want to check out a recent Wall Street Journal article by Rebecca Smith, which offers a more in-depth examination of the role of the necktie in passing along germs. One new solution for doctors who just can’t bear to part with formal neckwear: the antimicrobial necktie. (Hat tip: Ted DiSante)

But here’s a much more interesting and broad-reaching suggestion, from a reader named Larry McColloch:

In the section on doctors washing hands, you apply economic theory and approach. It would be much better to view it as a “control systems” problem. In this regard, the doctors were operating “open loop” in that the germs on their hands are not visible. What really happened with the hand-culture experiment was that the results allowed the doctors to see the germs that were present; in control-loop theory, this is “closing the loop.”

You might want to apply the idea of feedback and control theory to many economics problems. No doctor would contaminate a patient with potentially killer germs if they knew they were contaminated regardless of economic implication. What is missing in the hospital is feedback. You are also pointing out a product for someone to make money with. If someone can make a device that easily lets doctors see germs on their hands, it will immediately change habits in the hospital.

The control systems perspective also applies to many of your other topics, such as climate change. What is lacking in both understanding and fixing climate change is some kind of feedback mechanism, although I don’t know how to get appropriate feedback.

I agree with Larry: feedback is hugely important in problem-solving and, unfortunately, a far-too-scarce commodity. That’s one reason the Internet is so powerful: if you can find a way to filter out the noise, the Internet is one of the greatest feedback loops imaginable, at least for certain kinds of problem-solving.

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  1. AaronS says:

    I’ve wondered why, with our hand gels and so other anti-bacterial stuff, that instead of the involved, time-consuming (and perhaps half-heartedly done) “scrubbing,” our surgeons/doctors could just either submerge their arms and hands in a tub of the hand gel…OR have up-to-the-elbow latex gloves that are largely filled with the gel. So you just put your hands in the gloves (effectively “submerging” them in gel).

    Wouldn’t that be faster and just as effective?

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  2. Don the libertarian Democrat says:

    Ask your doctor to wear gloves when he examines you.

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  3. Scoop says:

    Larry’s observation has much truth in it, but it’s not directly on target. Doctors are not stupid. They know with 100 percent certainty that there are germs on their hands when they fail to wash them enough. But when they can’t see the germs with their eyes, the whole thing exists only as an abstraction in the mind that isn’t powerful enough to make many doctors take action. Making the germs visible doesn’t give the doctors even a shred of new information, but it might be enough to force them to make use of what info they have.

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  4. Bob says:

    AaronS – nope!

    Removing the things that the cleaning products cannot kill is far more important. Good old soap and water will do that best.

    The alcohol gel is great for some bugs, but you should also wash your hands.

    I agree that a feedback mechanism would be good. On the spot culturing of medical staffs hands with the results shown on hosptal website maybe?

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  5. Emily says:

    Hand sanitizing gel (that is 60% alcohol) is largely effective, but does not kill all microbes. For example, it does not kill Clostridium difficile, a major problem in many hospitals.
    Also, hand sanitizing is often performed inadequately. Medical professionals need to learn how to apply hand sanitizer appropriately and how often it can be applied before the hands need to be washed.

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  6. Jennifer says:

    Prevention of the spread of germs should not be the sole responsibility of physicians but should be expected from everyone in the less than sterile healthcare environment. First, start having each patient, caregiver and visitor wash their hands before entering the premises and require all healthcare professionals to do the same throughout the day.

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  7. Carolyn says:

    AaronS – It’s not as effective.

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  8. Timothy K says:

    @ AaronS There are water-less hand scrubs used in many ORs in place of the classic soap and water scrub. One example is the product Avagard, which is very similar to consumer hand sanitizer gels. I’m sure there are other products that are similar.

    The issue is that there are some organisms that still need soap and water to be effectively removed from the skin, and so the first “scrub” of the day should always be soap and water.. The best example is Clostridium difficile (“C. dif”) a common cause of hospital acquired intestinal infection.

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