The vast majority of patients have never asked a physician or other health professional if they washed their hands before a physical exam or medical procedure, said a survey released in September.

Only 21% of patients have asked about hand hygiene in the hospital, and just 17% have inquired about hand-washing at their doctor’s office, said the nationwide online survey of 1,020 U.S. adults. Fewer than 10% of patients said they ask “frequently” or “all the time.”

The low rate of hand-hygiene quizzing comes despite widespread use of hospital signage encouraging such questions, as well as educational videos and urging from the Centers for Disease Control and Prevention, the Joint Commission and others. Compliance with hand-hygiene guidelines is difficult to measure accurately and varies widely. The CDC says the hand-washing rate in hospitals hovers around 50%. Poor hand hygiene is a leading contributor to the estimated 1.7 million health care-associated infections that occur each year in the U.S., the agency says.

More than 40% of the patients surveyed did not ask about hand hygiene because they assumed health professionals always wash their hands before treating any patient. About 20% of patients do not believe it is their responsibility to ask, and 7% felt too intimidated to do so. Only 18% feel “extremely comfortable” quizzing doctors about hand-washing, said the survey, conducted by ORC International on behalf of Kimberly-Clark, the Roswell, Ga.-based maker of hygiene and health care products.

Young patients are likelier to query doctors on hand hygiene, the survey found. About a quarter of patients 18 to 34 years old have asked about hand-washing, compared with 6% of seniors.

Signage and other efforts encouraging patients to ask about hand hygiene are important, even though patients seem uninterested in taking on the chore, said William Jarvis, MD, a pediatric infectious diseases specialist and former CDC official.

“One in 20 patients who goes into the hospital is going to get one of these health care-associated infections, and we need to educate patients about ways to prevent them,” said Dr. Jarvis, who does consulting work for Kimberly-Clark. “As they understand what the risks are, these signs are reminders to them to remind health care workers about hand hygiene.”

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