I'm shocked at the low level of attention to hand hygiene in Dutch hospitals. I have seen the majority of health-care workers involved in direct patient care with body fluids, i.e., taking blood, giving infusions, changing bandages, not wash their hands before or after and not wearing gloves.

This is with a seriously ill patient with a low resistance who has already had hospital acquired infections! You would think that especially with swine flu being so prevalent, that they would be more cautious about this.

I've asked the staff about it and always get ridiculous replies like "we don't have hospital infections like in the US or the UK" or "we Dutch are very clean". They are unbelievably niave, arrogant and just plain dangerous.

I've printed this image and am going to be placing it by the bed. I'm expecting to receive a lot of criticism from the staff, but after repeated requests, nothing seems to be getting through to them.


SAVE LIVES: Clean Your Hands is part of a major global effort led by the World Health Organization (WHO), to support health-care workers to improve hand hygiene and thus stop the spread of life-threatening, health care-associated infection (HCAI).

Here are some links in Dutch about Bad hand hygiene in Dutch medical care:

Onderzoek naar handhygiëne; 40 % verpleegkundigen wast handen niet wanneer het moet

Te weinig kennis over handhygiëne bij artsen

At last somebody else has noticed this ...

I have been visiting a friend in hospital quite regularly in the last few months and have been amazed that there are no hygienic handwashes positioned around the hospital for people to use.

I have witnessed in Intensive Care people visiting, coming straight off the street without any handwashing, into the ward. Indeed I can imagine the ridiculous retorts I would get from the hospital staff if I mentioned this. I have said this before - I wonder where these people get trained and what sort of level they have to reach, as they have almost a 3rd world country approach to medicine and hygiene. It may be that a particular hospital has a low incident of infection, but surely it's just common sense to ask visitors to wash their hands before seeing a very sick person?

I wish you luck with your campaign but sadly I don't think it's going to change their views.

Don't even get me started on the hygiene of visitors...

I witnessed many times up to 7 visitors in a shared room in ICU, including 3 of which where children, and nobody washed their hands. It's outrageous enough that they allow so many visitors/children in a shared ICU room, but that none washed was even more upsetting.

I had to insist many times that the rules were followed -- max 2 visitors at a time. I also washed my hands incessantly, hoping they would get the hint. I found it kind of hard to be too harsh when everyone is in a life-or-death situation, but wish that the nurses would have helped more.

I still feel a bit sick over the blood taking proceedure. I can even handle the notion that they dont need to wear gloves as they are not touching much, but I have never seen them wash hands between patients, and they ARE touching the area that they put the needle into immediately- surely that can carry bacteria into the bloodstream?

I am used to people using a new set of gloves for each patient. It makes me very uncomfortable that they dont.

Is there any evidence that it causes problems? Or is it just that we are used to something different?

Well to be honest... when I was a kid... my mom was in the ICU a number of times and I don't remember washing my hands when visiting her. Either in ICU or regular rooms either.

As for doctors not washing their hands...I can't say I have spent much time with patients, but my partner is an MD and part of dutchie medical school is learning to wash hands properly.

It is a common misconception that the type of infections in healthcare environments are caused primarily by the bodily fluids, i.e., blood. Most hospital-acquired infections (or more generically healthcare-associated infections) are caused by contact with the someone who has one, and because sick people go to hospitals, the risk is higher in them.

The pathogens colonize more in some areas, and the hands are one of the biggest places. So a healthcare worker who took blood from someone with an infection, who may have only touched their arm, can easily transmit it to you by also touching you.

For healthy people, they can often carry the pathogens without even knowing it and not get sick. For people who are immunocompromised, and less capable of battling infections because of an immune response that is not properly functioning, they can be deadly.

Here is a good overview: http://en.wikipedia.org/wiki/Nosocomial_infection.

Overall, I see doctors doing hand washing more than nurses here. Unfortunately, it is the nurses and other care workers who have the most physical contact with patients, and need to be even more vigilant.

Times have changed. There are some nasty bugs and infections you can pass on to a sick person with a compromised immune system, which can be potentially very serious. Most people carry infections but their immune system fights it off, which is why it's so very important not to bring these germs into a hospital.

In an ICU ward here I have seen people bringing in stuff to the sick person straight from a shop - who knows what germs the shop assistant has on their hands. Hankies don't seem to be very popular here and everybody I have seen on public transport sneezes into their hands and then touches the stop sign and exit button. If you haven't got a hankie sneeze into your arm, not your hand.

I carry dry wash hand disinfectant with me and use it before every trip - and then wash my hands after the trip. It makes me cringe when I see people coming in to work and without washing their hands take a coffee from the machine. It only takes a few minutes to wash hands and it can help contain viruses and especially this new flu which they predict to spread during the autumn and winter months.

Of course it would also help if people covered their mouths when they coughed or yawned as well, but I suspect that may be a step too far!

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The same is true of hygiene in most hospitals the world over- I work in a US hospital in San Francisco and I would gather that about 40% of the nurses and/or doctors don't adequately wash their hands; often the use of gloves provides a false sense of security for the nurse and/or patient.
Handwashing is essential usu. after 10-15 applications of any hand degermer.
In addition, gloves really only protect the provider of care in terms of blood draws/venipuncture.
Gloves in and of themselves do not prevent the spread of germs with the exception that they provide a physical barrier for the patient not receiving bacteria from a provider that normally wouldn't be found on the skin- hence handwashing is essential to reduce the number of bacteria on the skin and prevent transmission of opportunistic bacteria from being spread from one person to another.

I don't think NL is any different in this regard. Just make sure that if you are immunosuppressed or in contact with someone who is that you practice good hand hygiene and insist that others do as well.

The NL is different. No disinfectant for handwashing after coming from the outside for visitors which is mostly standard now. I know that gloves aren't meant to replace washing hands, but they are there for the protection of the provider. If they take blood from a patient who has just walked in to a blood testing center they have no idea if they have any transmittible conditions. Therefore it's essential to wear gloves in case of prick accidents or if they have a very small cut. This is standard practice, except in the NL.

And you know that because you visited hospitals in all countries of the world?

Why come up with this sort of remark? Are you Dutch by the way? It is standard practice to wear gloves when taking blood - full stop. No amount of arguing will ever justify taking blood without gloves. As I explained before this is for the benefit of both parties. Also washing hands is vital to prevent the spreading of germs. I suspect you are Dutch because they always come up with the old chestnut that there is always a place or situation which is worse than the Dutch, trying to justify bad practices.

Just accept that the Dutch are very bad at hygiene - especially when it comes to washing hands after using the toilet. I know because I have seen this happen time and time again and have been horrified.

To be fair, no brushing one's teeth isn't good hygiene either and I read that you happen to be a Brit and if there is one Western country with bad teeth...

I agree, but it's probably more to do with the fact that there is a shortage of dentists in the UK and if you are working expensive to get treatment.

I must say that after staying with some Dutch I did notice that cleaning teeth first thing in the morning, before breakfast, wasn't standard practice. Not pleasant for the rest who have to sit at the table with them. Toxins build up on the teeth when asleep and to miss this vital step in teeth hygiene isn't a good idea.

Apparently not when it comes to hospitals - which this thread is about - unless this Dutch characteristic has arisen in the last two years.

A couple of quotes from http://news.bbc.co.uk/2/hi/programmes/poli...how/7080658.stm

To be fair I don't do that either, I usually have breakfast after getting out of bed immediately and brush my teeth and shower after that.
On TV folks Frenchkiss just after waking up, I wonder how they do that

Complete and utter nonsense. The Dutch aren't bad at hygiene at all. I see people wash their hands after using the toilet all the time. And everyone I know brushes his teeth in the morning and in the evening. And how do you know if they wash their hands or not between patients? There is always some time between patients when the doctor or nurse is alone. Maybe they clean their hands when there is no patient around.
By the way the Dutch healthcare is the best in Europe according to the Euro Health Consumer Index. I know that is hard to swallow for you, because according to you this is a third world country. But the facts state otherwise. The Dutch are healthy and life expectancy is very high. And when I visit a hospital I always think they are very clean.
And yes I am Dutch by the way. And I also think there are lots of things wrong in this country. But please put things in perspective. There are also good things. And hygiene is one of those things.

Perhaps no health care system is perfect but I think the Dutch system wins hands down if you compare it with the National Health in many parts of the UK.
I had to spend some time in a hospital in England as one of my family members was very poorly and I have never seen such filth, indifference to hygiene or neglected patients (some of the worst cases in the intensive care unit). There were indeed hand washing machines on every ward wall and very few people used them - including the staff. Many people complain bitterly about the health care system in the UK and the excuses are usually given that the problems are due to underfunding.
As for the Netherlands having poor health care and hygiene standards - perhaps again this is down to individual experiences but my husband had to have treatment at a hospital here last year and he was very well looked after and the ward and staff were spotless. The aftercare was excellent also and the outpatients area was cheerful and clean.

I couldn't agree more with you, as a Brit. I also think there are major differences in hospitals between the two countries. I've been inside 4 hospitals here and all are modern or have been remodelled. Quite a few of the buildings still in use in the UK are the original workhouses of the late C19, which have just been added to in a hotch-potch fashion over the last century. Even my old local hospital still used (uses?) such ancient wards with layer after layer of paint covering the brick walls and sash windows (!). Hygenic? All the hand gel in the world won't prevent the germs living in those wards.

I agree with the above quotes, but they have nothing to do with hand hygiene, which is very poor here.

MRSA - Methicillin-resistant Staphylococcus aureus has to do with the use of or selective use of antibiotics, which I think the Dutch do well. I am talking about the basics on how patients acquire Staph and Strep, not about how they are treated. Hand hygiene plays a significant role in that.

Actually, it is quite easy to see if they wash their hands on entering an ICU patients room. They do, or they don't.

I'm so absolutely tired about hearing "best in the world" stuff about Dutch medical. Those polls are usually targeted at the citizens, and if the citizens know nothing different (for example customer serivce or the lack there of here), and are complacent (as the Dutch are in my view) they will come up high in the polls.

And by the way, not everyone is from Europe here. I am basing my experiences on some of the best hospitals in Boston (I lived within a kilometer of at least 10 world class facilities). The standards here are 20+ years behind them in my view. After witnessing/participating with my partner 14 weeks in hospital here, I hope I can afford to go back to Boston if it ever happens to me.

Overall, I think the medical care is good, but hand hygiene is lacking. I just went through 3-4 life-threatening hospital acquired infections with my partner, and you can tell me I don't know what I am talking about, but you will have a hard time convincing me without facts.

One thing that has disturbs me is that when I've had blood taken, they don't wear gloves and when I asked about it, got the usual Dutch "it's not necessary" answer - I looked it up on the WHO website and it disagreed with this. ....also, my wife had a pap smear and no gloves were used....is this another case of "statistically it's a low probability anything will happen so we won't bother" ? I find the Dutch like to use statistics to dismiss things - unfortunately this attitude has messed up my wife's health (there was 80% chance she would recover without some simple meds so they wouldn't give them to her!)....

The Euro Health Consumer Index isn't a poll. It isn't the result of a survey among "customers"/citizens.
And I am tired that it is so hard to swallow for some that there are actually things very good in this country. Health care being one of those things.
And Monkeynuts claim that the Dutch don't wash their hands after visiting the toilets is complete bollocks. Simply not true.

The dutch medical saved my life or at the very least has probably given me an extra 20 yrs of good health.
I've not had that much experience with the hospitals(anywhere) but I underwent some serious treatment which made me very ill at times.
The staff were always very understanding,encouraging and supportive...in fact they want me to be part of a presentation...and I'll do it just to say 'thank you' - and a couple of the nurses were pretty hot too :o)

Maybe my use of "poll" was not completely accurate, but the Health Consumer Index (EHCI) is primarily consumer based survey. Let's not get hung up with semantics Okay? Also, I am talking about hand hygiene, which is not talked about in the Health Consumer Index (EHCI).

Hand hygiene is very important, and the best way to spread the word is to talk about it. If you are going to get your knickers in a twist because I happen to bring up something that needs education about, I don't know what the point is of this forum.

For those interested, the last version of the full EHCI on the web for 2007 http://www.healthpowerhouse.com/media/Rapport_EHCI_2007.pdf, and the 2009 version is out at the end of September. Here is a summary of 2008 http://www.healthpowerhouse.com/files/2008...2008-report.pdf

I was shocked to see my huisart shaking hands with the last patient before taking me in, then continuing examination, farewell shakehand and again welcome shake hand to next patient. All without water, soap or sanitizer. You don't shake hands with patients, not in this age. I agree that the hand hygiene in health care is scary. In other places, I would refuse to be treated this way, being an English speaker with only your Huisart to go to, I think I have to accept. I also agree that Dutch healthcare itself is a good system, but you have to prove you are dying before getting the real good care that is available.

Pepe, let me tell you in very plain and simple language. I work in a company with Dutch people. I use the toilet. I have witnessed with my own eyes bad hand hygiene. I have attending a party where there was no soap in the toilet or kitchen. I had to hunt down a small piece in the bathroom. What part of this is simply not true? Are you calling me a liar?

The level of care from huisarts is absolute rubbish in this country. They don't appear to have any diagnostic skills or level of knowledge of any known ailment. After I was discharged from a hospital in Amsterdam, after being told that a board of doctors had studied my case and had no idea what the solution was, I had to get my correct diagnosis and treatment from my brother's GP in the UK, after one visit. That, my friend, is not very good healthcare.

I agree that the NHS is struggling, through lack of funds, with out dated buildings and equipment. If we had health premiums, like Holland, then we might be able to do something about this lack of money. But you can be assured, if you set foot in the UK, slip and break your leg, you will be treated without charge, which is more than can be said about Holland.

I have had experience of both countries and I would rather be treated by a caring doctor who truly cared and investigated on your behalf any symptoms, than have the shining new equipment and robotic care, with people who only looked at percentages and numbers, instead of treating the whole person with dignity.

You Dutch are so brainwashed you can't see problems when they are right in front of your face. In your insistant that everything is fantastic here you are seriously putting your own citizens at risk, but rather than put them right you would rather do the blank look and turn away.

Taking criticism and acting upon it is a sign of maturity, not weakness.

Unless the Dutch stop their finger wagging and over inflated sense of worth and start to listen, then I just despair.

I have to agree. I have never seen my huisarts washing her hands after or before me. Last time she was couching loudly and seemed to be sick herself.

When I had to give blood samples, in all three cases there was no alcohol wipe to clean my skin before the puncture. Next time I will bring my own wipes and propably needles as well.

I have to say that Dutch lack of hygiene in healthcare has been really surprising.

I think the one thing that people are forgetting is that in general the risk of transmitting a life-threatening bacteria is nil unless you have some degree of immunosuppression. And that would apply for patients with leukemia who have undergone BMT or patients with immune disorders that weaken their killer Tcells/CD4 counts (i.e., in the case of uncontrolled HIV).
Overall, the risk of receiving a life threatening bacteria is small if you practice good handwashing before eating or touching your face/or mucus membranes. You won't get anything from passive contact unless it is via a break in your skin.
The use of alcohol to degerm the skin is important for venipuncture, but not essential. We have normal flora on our skin (staphy epidermis/aureus) that we would hope to minimize in terms of becoming bloodborne, but in most situations where you have a normally functioning immune system, this should not become a problem.
I would urge all of you to become an advocate for yourself, and if you feel that your personal sense of hygiene is being impacted, insist that the health care provider take better precautions or don't submit to the procedure or blood-draw. And look at incidence rates in terms of antibiotic resistance- thankfully NL has very low rates d/t the fact that they judiciously prescribe medications when necessary. Even ABX have health risks, esp. as we are beginning to find out in children and those that are chronically exposed and yet fail to complete an adequate course of treatment.

And while the blood samples are taken from 200 patients a day, with people bearing MRSA and nurse never washing hands, the odds are still small? No, with people responsible for these actions, there is now justification omitting the most basic hand hygiene for personal lazyness. I can't remember been asked about my immune system or HIV status.

I'm afraid this seems to be something counter-medical, a false argument that all natural things should run their course. A proper risk assessment would advise always to take the least risk approach.

But doesn't exposure to certain bacteria strengthen your imuune system?
And aren't anti-biotics often prescribed unnecessarily ?

I find the Dutch approach things differently - they tend to dismiss things as unnecessary if the percentage that nothing will go wrong is high. For example, my wife being denied time-sensitive medicine because there was an 80% chance the illness would go away naturally. Unfortunately she was in the 20% ... I later found out that if the medicine had been prescribed, there was a 90% of a better outcome... The least risk would have been to give the medicine just in case she was in the 20%, but the 80% chance of natural healing was high enough that they couldn't be bothered....I find it a very frightening MO....at least her illness wasn't life-threatening...but still

I thought I was the only one who noticed this.

On one of those fancy joint appoints with my parter, the doctor shook both our hands and then proceeded to examine my BF's foot which had some kind of a nasty bacterial or fungal infection going on.... with her bare hands. WAIT..... then she goes and types it into the computer, looks through a book, and writes a script. All without gloves or washing her hands. I felt like there should have been a voice over describing how bacteria spreads.

Oh yeah, I forgot to mention. She was pregnant too.

I've sometimes wondered if the Dutch GP medical examination is a 10-question multiple choice quiz in which a majority of the answers are paracetemol or "do nothing".

Thats funny and scary. You probably have similar experiences, after finishing the symptoms quiz, my husart usually asks "so what you want me to do?" and then I have to say give me something to make me feel better etc..

His favourite punch line is "we don't give antibiotics in Holland"

Monkeynuts, let me reply to you from the beautiful city of Shiraz in Iran: Everyone I know of, Dutch and not Dutch, washes their hands after using the toilet. My parents taught me when I was a little boy to do so. So you are telling the truth the way you experience it, but so am I.

Also I never had a problem to get pain relief, anti-biotics, or whatever other medicin I needed.

I've always felt nervous about the Dutch medical system, but wasn't really sure why. The lack of real "caring" was fairly evident. Sometimes I feel so "brushed away" by the doctor.

And nevermind the lack of discreetness. In Australia, if you have to undress the doctor gives you a towel and let's you undress behind a curtain. I know they end up seeing all your "bits" anyway, but it's just weird as a female undressing while the male doctor is standing there watching you. Something that makes me feel very........very........uncomfortable.

I did ask for a towel once, and I was so embarrassed by their reaction and their resultant flustering around looking for one that the next time I just decided to grin and bare it.

It looks like Dutch medical care are finally taking hand hygiene more seriously. At a recent visit to the local hospital they had finally put hand sanitizers by the beds and they had some videos on the tv monitors about it. All I can say is that it is about time!

We recently had blood pricks, and still there was not hand hygiene by the phlebotomist, but hey, I guess 'Rome was not built in a day....

Like most things here, with the exception of things they can get international attention on, it's about 10-20 years behind the rest of the developed world.

Antiseptic concept? NL is about 100 years behind.

But is the rates of infection that much higher than elsewhere as a result? Are there statistics?

Maybe there's something in what my Nana used to say, "You gotta eat a peck of dirt before you die..."

That is bullcrap.

Unlike in the UK you don't have to call the police to get a glass of water at a Dutch hospital, and if it's that bad in the UK it's going to be even worse in Kiwistan so who are you kidding?

I like mud pies.

Was Nana a hillbilly? Cuz that's hillbilly (aka: dirt eater) wisdom. Is that what passes for science in Canada?

http://www.privatehealth.co.uk/private-hos...n-rates-abroad/

I'm sorry? I don't remember insulting you.

In fact, who ARE you?

Interesting taco. Too bad the database isn't more simplified so we can get a comparative overview...

Its one extreme to the other.
People on trains putting 'ultra-protection-against-every-disease-known-to-humankind' handcream.
Ultra hygeinic washing up liquid and cleaning fluids.
Paranoid obsessive bollocks if you ask me.
I'm not the healthiest of creatures but I hardly ever get ill - and when I do,its mostly self-inflicted....or that last 9 percent beer didn't agree with me.

No wonder those poor little bacterias are mutating all the time.

Thing is, there is GOOD bacteria (that's eating the bad stuff)...so I get concerned that all that anti-bacteria cleansing is killing the good stuff, and encouraging the bad stuff to get tougher to fight the cleansing!

Actually, I've had fewer colds since moving here; I used to get one per season, guaranteed. Now? Maybe one a year...if that...