Providers Should Get Used To Hand Hygiene Demands

To increase hand hygiene, a nurse at Massachusetts General created a rap music video to promote the use of sanitizer.

At hospitals in Maryland, employees are masquerading as "secret shopper" observers to mark who washes and who doesn't.

At Beth Israel Deaconess in Boston, the emergency department turned the use of gels, soap, and water into a game of tag. Whoever got dinged for missing a cleansing had his or her name posted on every computer monitor throughout the hospital, and was "it" until he or she dinged someone else.

Every week, it seems, there's another story about a creative way to promote self-disinfection.

Now the federal government is getting more involved with a video that urges hospital patients and their visitors to make sure they witness doctors and nurses—and anybody else who touches them—washing their hands at the bedside.

The video, launched by the Centers for Disease Control and Prevention, is being played on closed-circuit TV in dozens of patient rooms, lobbies, and emergency department waiting areas to empower patients to speak up. The video's goal is to convince patients to not be afraid to remind the caregiver if they don't actually see them washing their hands.

In the video, John Jernigan, MD, a deputy branch chief with the Centers for Disease Control and Prevention and another caregiver—a nurse or doctor called "Gail" who appears in blue scrubs—tell patients not to be embarrassed. Even if the doctor or nurse said he just washed his hands outside the room, they should order him or her to do it again. It's OK.

"Doctor, I'm embarrassed to even ask you this," the video depicts the visitor saying. "But would you mind cleansing your hands before you begin?"

"Oh I washed them right before I came in the room," the physician reassuringly replies.

"If you wouldn't mind, I'd like you to do it again in front of me," the young woman says insistently, pointing to the gel dispenser by the door."

The video was shot at Emory-Adventist Hospital and Emory University in Atlanta, in collaboration with the Association for Professionals In Infection Control and Epidemiology.

That's what I call an in-your-face hand hygiene!

Can you imagine that? A doctor or a nurse listening to a grandmotherly patient lying in a hospital bed saying "I want to see you wash your hands, right here, right now. Not another step until you do!?" And when the doctor says he already did, she in essence says, "I don't believe you. And if you did, do it again."

The video says it's OK.

It may seem that fears of the spread of infection—perhaps augmented by H1N1—or transmission of increasingly difficult strains of clostridium difficile or newer, hardier strains of methicillin resistant staphylococcus aureus, may be influencing a new sense of urgency on the issue.

Studies suggest that when caregivers are secretly monitored, they wash their hands only 50% of the time to prevent transmission. And when those same caregivers are asked, however, they think they cleansed 90% of the time.

Healthcare acquired infections are an increasing bête noir for hospitals. Not only are they estimated to affect 1.7 million patients each year, but 99,000 patients will die from them. And there is the cost of caring for patients who get infected, estimated at $35 billion to $45 billion a year.

And, of course, in October 2008, the Centers for Medicare and Medicaid Services instituted a policy that it will no longer reimburse for the additional care required for patients with hospital-acquired infections.

So there's a lot more at stake.

How aggressive will hospitals be to get better hygiene compliance?

I've heard and read about other ideas for hand hygiene, such as at Barnes-Jewish St. Peters Hospital in St. Peters, MO. Providers are giving each other Dalmatian-spotted cards that either carry rewards (such as a $2 coffee shop coupon) for good hand hygiene practices, or bad practice cards that say "We are putting you on the spot for not using hand hygiene."

Who knows? But I've even heard about using wireless technology that would give the provider a gentle buzz or zap if they entered a patient's room and neglected to tap the dispenser.

That may be going too far. But then again, maybe not.