The major result of the study by Garbutt et al—published in the 9 November 2007 issue of the NZMJ; http://www.nzma.org.nz/journal/120-1265/2810—was that only 1.5% of an observed population adhered to recommendations for hand washing and drying. Given how few adhere to the recommendations, it is curious that in the discussion there was no consideration given to amending the recommendations.

This study could not measure meaningful outcomes; how many people suffered from illness as a result of not washing their hands? I could find no study in the references documenting the risk of illness after urinating. Such a study may well not have been done, but I think it highly unlikely that any of the unwashed people suffered any untoward effects.

We need to be careful not to assume outcomes in relation to cleaning. We used to think that cleaning the skin before injecting was necessary to prevent infection, however since 19691 there have been studies that showed that it made no difference to infection rates and made the injection more painful. Current recommendations are that it is not needed.2 Only recently have these findings been adopted. Just think of the time and money wasted on alcohol swabs over the years.

I would argue that the message we need to promote is that people need to know how to wash their hands thoroughly and need to know when such washing has a high potential benefit such as when visiting the neonatal unit, after handling raw chicken, and whilst suffering from a diarrhoeal illness.

It could be that those who do not wash after urinating are not convinced of the benefits of doing so, based on their personal experience. They might be right.