Death to the Microbes

Our latest “Freakonomics” column in the New York Times Magazine is about hospital-acquired bacterial infections, and how doctors don’t always do a very good job of washing their hands, and how one hospital set out to fight this problem. As always, we’ve posted some of the research behind the column elsewhere on this website.


Some doctors have proposed having medical personnel wash their hands with yogurt. The idea is that antibiotics kill off nearly all natural bacteria, creating an attractive surface on which bacteria which are naturally weaker and can't compete -- but which are resistant to antibiotics -- can thrive.

This Google search pulls up several references to this idea. I read a long article about it in the Toronto Globe and Mail last year.

for example this one:


A good essay on an important topic.

Clem Snide

I recall reading a newspaper article a few months ago which mentioned that colds and flu were reduced by something like 56% on a US submarine by getting the submariners to wash their hands five times a day, although I can't find reference to it in Pubmed. The scientific point being that these viruses are transmitted mainly by hand to mouth contact rather than via droplet inhalation. Earlier reports have mentioned doorknobs as a major route of virus transmission. Given the number of working days lost to colds and flu, I think a modified version of this screensaver saying something like "Wash your hands before meals" could have a huge economic impact.

Cyril Morong

Napkins may soon be able to detect bacteria. The links below are all pretty much the same. Just included 3 in case they don't all work. A brief description of the story is below

Cornell University researchers are developing a napkin that will be able to detect bacteria, viruses and other dangerous substances with a mere swipe. The napkins, made with special nanofabrics, could have commercial use in food preparation or health care, said Margaret Frey, a professor of fiber science and apparel design at Cornell. The biodegradable absorbent wipe is similar to a common household napkin but has nanofibers containing antibodies to numerous biohazards and chemicals. Users would simply wipe the napkin across a surface, and those antibodies would signal the presence of bacteria or viruses by changing colors, for instance, Frey reported on her work Monday at the American Chemical Society's national meeting in San Francisco. She said her research team has applied for patents and is looking for commercial partners, though the napkin is still a few years away from commercial production.



I know a hospital nurse who was assigned the task of looking into how well the hospital was doing at keeping clean. She found and reported that a particular surgeon was especially dirty, and consequently had substantially higher infection rates in his patients. That surgeon had her fired, and still continues in his dirty ways.


Point 1) I would like to see the evidence that any alcohol hand solution actually kills bacteria or is better than washing with soap and water. The only study I have seen came from a VA hospital, published in the CDC's journal for emerging infectious diseases. Should have been good. The control population did not wash their hands at all. Not much of an alternative. About the time I was in medical school the alcohol trays filled with instuments dissappeared, replaced with wrapped, dry autoclaved instruments. The alcohol bath was shown not to stop the growth of bacteria on the instruments.
Point 2) As this article showed, doctors will change their behavior given good evidence that the change really will benefit the patient.

I was very disappointed to read the first line of the next paragraph go back to incentives/carrots instead of evidence as the approach that showed promise for changing physician behavior.



Jewellery, especially watches, are primary hotspots that easily spread to washed hands

Political correctness and religious sensitivity, has now relaxed the ban on these items in hospitals.

The right to exhibit one's marital state via a wedding ring does not trump the rights of patients to minimal risks of infection by MRSA, etc.


My understanding of alcohol is that it has no antibacterial properties. Because it evaporates quickly and has a drying effect, it may kill some bacteria which require moisture but...that's not very effective in general.


Consumers Union has been running a campaign on this issue for a few years. They've been trying to get hospitals to report their infection rates. Part of the campaign, I think, is based on the idea that if people know what hospitals have higher (risk controlled) infection rates, they can choose to go elsewhere when possible. i.e. put the market on the job.


My team recently developed an elegant solution to this vexing problem - a simple wearable alcohol gel dispenser (gelFAST). When caregivers wear gelFAST they disinfect their hands more often, because barriers to hand hygiene have been removed and cleaning becomes a reflex (... have done and continue to do clinical trials on this). As hand hygiene rates increase, infections drop, mortality drops, and associated costs drop. Would be happy to share more on this, my favorite topic.

- Gilad Shoham, CEO, Medonyx Inc.


In order to preven contamination when exploring like Mars, NASA builds space probes in clean rooms and uses extreme sanitation measures to try to keep an earth hitchhiker from making it to another planet. The ultra-clean environment created almost ensures that only the most hardy microbes survive - and are the most likely to survive space travel to other planets. I wonder if something similar is happening in hospitals.


A comment above mentions a napkin being developed at Cornell that detects bacteria and viruses.
Could technolgy be used in the following manner - hand are placed on a surface and then thier image
is projected that give a real time visual of the
germs on the hands -
something a whole room full of people could see.


What part of “wash your hands” is difficult for doctors to understand? They set the example as leaders in hospitals and everyone sees that they aren't doing it. In 2002 CDC put out a guideline on hand hygiene that apparently doctors fail to follow 50% of the time. Imagine that doctors need a 56 page document on how to clean their hands. Then a full year ago, the World Health Organization put out a 34 page document on hand hygiene. Last month, JCAHO and others have embarked on an 18-month study to “identify best approaches for measuring compliance with hand hygiene guidelines in health care organizations;” and, uh oh, it is sponsored by the makers of Purell. Any bets that the study won't recommend letting us in on whether doctors are actually washing their hands. Is it really that difficult? The reason that we still have a problem is that there is no public accountability, only voluntary guidelines. Doctors know they should be washing their hands, there are signs all over every hospital to remind them, and yet there is still a problem.



My advice to the consumer is keep a box of gloves or bottle of hand sanitizer at the bedside and offer it to anyone entering the room. Asking "Did you wash your hands?" Puts trust in a failed system. Offer the product and there's no need for conversation.


Handwashing, gloves, alchohol-based hand rubs are all good interventions. However, no studies conclude that rates of MRSA and VRE (the 2 most out of control bugs in healthcare) are reduced with these alone. While these items may spurr many cottage industries and contribute to the solution, modern medicine has always controlled the spread of infection by first identifying the resevoir. And it makes sense. If you don't know where these things are, how can an institution as complex as a hospital ever control MRSA, VRE, C. Difficile or any other infectious organism ? And why have our healthcare leaders (CDC and others) refused to confront this epidemic this way, as they have silently watched over the last 3 decades, as the numbers of victims steadily mount?

The CDC recently called for routine testing for HIV upon hospital admission. SARS was treated similarly. Smallpox and Tuberculosis were similarly controlled. But MRSA and VRE, which have claimed more victims than all the above combined, doesn't warrant the same reaction ?

Do we wait for vaccines or new antibiotics as people continue to suffer and die ? Do we just continue the cycle of overuse of antibiotics and create even deadlier bugs ? Isn't prevention the sane approach ?

It appears that public awareness and public pressure applied to our elected officials is the only effective means of cleaning up our dysfunctional hospitals. There is much to celebrate about American healthcare. There is much that needs fixing. This is one area where new technology and more studies aren't needed. Action is all that's needed. Screen high-risk admissions for these diseases and impliment contact isolation precautions. It's worked for the Dutch and the Western Australians for decades. They don't have this problem despite the growth of community strains of these diseases.

Yet in America intransigence seems to rule the day. The people of this wonderful country certainly deserve better than what healthcare leadership has failed to deliver.

When it comes to this outrage, maybe accountability (i.e. lawsuits) will accomplish what the sacred value of human life has not been able to motivate.



PS. And since this is at least in part about economics, isn't good infection control (prevention) far more cost effective than treating the myriads of thos infected?


PPS. My reference to SARS, HIV and TB was meant to convey what has taken place in the US healthcare system. Not worldwide.


It does seem that it would be much more cost effective for hospitals to maintain their doctors with sanitized hands. Although the cost of creating incentives for the doctors that would heighten the percentage of doctors who wash their hands (as tested at the Cedars- Sinai) it does seem that it would be less than the 44, 000 to 98, 000 of hospital patients who die on average each year in the United States due to hospital errors and especially due to the spread of bacterial infections. Now at the same time it is surprising to know that as told in Freakonomics, people at work have a higher percentage of leaving a dollar in a wooden box to pay back the bagel man, Feldman, for their own selves to feel good... than doctors washing their hands! I mean don't you think that doctor's would have a high enough incentive for washing their hands, with the knowledge that their own bacteria could cause the death of one of their own patients, for their selves, as the bagel buyers did. But I guess in the end when those doctors were all shown the results of the petri dish, they decided in actually seeing the bacteria, that that was infact the right incentive which made themselves feel bad about what they were causing...




I had a couple of thoughts about washing up....

First, "scribbing in" as depicted on television appears to be quite intensive. What would happen if the surgeons simply had to immerse their hands/arms in a basin of alcohol--or hold them under and alcohol shower? That would make things super fast.

Second, with the technology we have, it seems like a physicians ID badge could be used to track which rooms they enter...and which Purel dispensers they operate. Very simply, if the enter room 101, but do not engage the Purel dispenser in room 101, it would be flagged.

Third, I am thinking that three times a day (or more), the hospital would have a "wash break." Every single person would have to wash up during that break (with exceptions for those in surgery, etc.), and be accountable to, say, two other people. Thus, when the wash break occurs, Suzy must go to Wash Room #4, and must meet with Peggy and Lily. No one can wash up alone. Also, they the ID badge would show they did go to the wash room.

Seems like a small price to pay to eradicate one of the biggest issues facing healthcare.


david sherr

Clean hands or not, Dr. Bender is not a competent physician. I went to him for a second opinion after an extensive series of tests indicated that I had Marion's Disease, a bladder condition that mimics the symptoms of BPH. Dr. Bender arrived in the office 40 minutes late for my appointment (he was not running late with other patients), gave me a very brief DRE and said, "you have an enlarged prostate, we have to go in and scrape it out". I told him about the Marion's Disease diagnosis and he scoffed and said, "I never heard of Marion's Disease." A third opinion, Dr. Raz at UCLA, confirmed the Marion's Disease diagnosis and I had a surgical procedure to correct it. My prostate remains normal to this date, eighteen years after Bender said he needed to "scrape it out."