Insiders' Insights

Are Your Hands Clean?

Hospitals are undertaking numerous initiatives to improve patient safety and reduce errors. Yet one of the basics--handwashing--remains one of the biggest challenges. Hospital administrators have tried various methods to ensure proper handwashing techniques among staff--with varying levels of success.

John Bartlett, MD
Chief of the Division of Infectious Diseases at Johns Hopkins Medicine
Johns Hopkins University School of Medicine, Baltimore

Many people have tried to monitor handwashing by observing healthcare workers to see who does it and who doesn't do it before doing procedures or before going in a room. A report card issued by the hospital on an individual is something that people take very seriously. Public reporting is another way to do it, because it potentially has a very important impact on getting not only the individual healthcare worker's attention, but the administrator's attention, as well.

One of the problems with public reporting, however, is that once people gain knowledge of the system, they learn how to outfox the system. But if we could all be comfortable that what we are reporting is the same, everybody will feel good about it as long as we can put in some sort of controls that will make it a level playing field.

Lisa McGiffert
Campaign Manager
StopHospitalInfections.org

There's a sort of "top-down" attitude that has to spread around the hospital to improve hand hygiene. While CEOs and CFOs would certainly play a role, doctors are perhaps most important. This is a big problem--we have a situation where doctors are the worst compliers, and yet they are leaders among the staff. We also know that in the past several years, hospitals across the country have initiated some type of handwashing campaign. But what is not happening enough is measuring the success of those campaigns--or the measurement is showing that the campaign is not working.

There may need to be other efforts, such as transparency, to go along with that measurement. I think you definitely have to let staff know you are watching and that there is going to be some public accounting of it. Frankly, I think we need to get to a point in hospitals where not washing your hands makes you an outcast.

-Ben Cole