Rigorous Hand-Washing Will Be Part of Covid-19's New Normal

The Trump Administration has committed to reopening the economy at all costs, the White House coronavirus task force has vanished from view, the Centers for Disease Control and Prevention was silenced for three full months—and a coronavirus vaccine is more than a year away. As the United States opens up piecemeal from lockdown, what happens next in the pandemic is being left up to the decisions each of us make: to observe social distancing, to wear a mask, and most of all, to wash your hands. The last of these is the simplest to do, and was the first piece of pandemic health care advice most of us got. But as the people who do it most—health care workers—can testify, it’s challenging to do it consistently and well.
sanitation workers cleaning stairs

Everything You Need to Know About the Coronavirus

Here's all the WIRED coverage in one place, from how to keep your children entertained to how this outbreak is affecting the economy. It’s been 174 years since obstetrician Ignaz Semmelweis noticed that two wards in a Vienna maternity hospital had strikingly different rates of post-childbirth infections—and that what made the difference was whether or not the health care personnel taking care of the new mothers washed their hands before examining them. It’s been two decades since an explosion of superbug and C. diff epidemics demonstrated how many of the 2 million infections that occur in hospitals each year are passed between patients by health care workers. Handwashing in health care is pushed by the CDC, it’s a favorite message of the World Health Organization, and it’s the backdrop to the entire medical specialty of infection prevention and control.
Yet it’s a surprisingly difficult thing to get health care workers to do. Even though they’re bombarded with messages every day of their working lives, the CDC estimates that health care workers clean their hands on average less than half the times they should. That’s despite knowing that somewhere between 50 and 70 percent of the infections that occur in health care settings in the US each year could be prevented if hand hygiene was followed more faithfully. “Hand hygiene is the bane of our existence,” says Saskia Popescu, an infectious disease preventionist and epidemiologist in Phoenix. “No one gets it right all the time.”

This is an important thing to think about, because as we move into Covid-19’s new normal, all us civilians will need to routinely do things that even professionals find hard. And we’ll mostly be making the decisions to do them (or not) out of our own volition, because there’s not yet a public health campaign—the kind that puts commercials between TV shows and signs on bus shelters—to remind us. A good portion of the population may not even have a memory of what those are like: The seat belt campaigns of the 1980s and the condom-use campaigns of the 1990s are a generation in the past.

As the campaign to improve hygiene in medical settings shows, figuring out what prompts people to act is a work in progress. People who spend their professional lives in infection control say that its failures and successes offer some important lessons for getting the rest of us to protect each other. The first thing to do, oddly enough, may be to admit the failure—that is, to make it clear that what people are being asked to do is outside of their normal behaviors and therefore hard. The second is to recognize that not everyone fails to comply for the same reason.

For example, for some health care workers, the problem is lack of knowledge or missing out on training, says Diane Cullen, who is associate director of standards interpretation at the Joint Commission, a nonprofit organization which audits and accredits health care organizations based on how well they prevent infections and promote patient safety. For others, it’s not agreeing with a policy. “Lack of buy-in,” Cullen calls it: “A staff member might have been trained in hand hygiene but is too busy to do it, or doesn’t feel they need to do it as often as the regulations say.” Still others might not bother with washing their hands or lathering up with alcohol gel because they’re not concerned about the consequences if they’re found out—either punishment from their workplace or disapprobation from their peers.