Can you really teach people to wash their hands?

Occasionally I'll see in the American newspaper breaking stories about how rarely doctors wash their hands.  Or even the average American citizen.  Maybe getting people to wash their hands is actually much harder than one would think.

But Americans don't seem to suffer from diarrheal disease, typhoid, and all these other fecal-oral diseases that plague many developing countries.  Why not?

I'm convinced that Americans are essentially saved by two things: utensils and toilet paper.  Their hands have essentially been removed from both ends of the equation, which drastically reduces the opportunity for transmission and consumption.

Maybe the WASH folks are going about this the wrong way--why can't we start an advertising campaign to get people in places like Bangladesh to eat with a fork and a knife, and wipe with toilet paper?  Perhaps started with the wealthy so that this might be perceived as a "wealthy" behavior (and therefore something others aspire to)?

It's easy to get tunnel vision on the "best" outcomes, or the "ideal" outcomes, but it's important to keep looking for other approaches that we may have missed.  Sure, people should wash their hands.  And use condoms.  And wear their seat belts.  But unlike economists, we can't just assume rational behavior, especially when we've got a lot of evidence to the contrary.  So we also have to think about which behaviors are easier for people to pick up, even if the gains are marginal compared to "best" case.