I only washed hands before the Physical Exam. I also didn't shake hand with everyone. I went in said hi and introduced myself and if the patient seemed to go for a handshake I went for it too! LOL! Also, I strongly suggest using hand sanitizer over washing your hands. I washed my hands on every single patient because I couldn't find the sanitizer for like half of my patients (NERVES!!) and when I finally located it, I was half way through my exam and didn't want to change my routine but it is just there by the door and it saves you tones of time. At least in Philadelphia the soap does not wash off easily and the tissues absorb NO water!! Annoying!