Secret Shopper Program Checks Hospitals' Hand Hygiene

HealthLeaders Media Staff, November 13, 2009

A Maryland health coalition has launched what has been nicknamed the "secret shopper" hospital project in which teams of unidentified employees will monitor colleagues' hand hygiene each time they exit a patient's room.

Organizers say the Maryland Hospital Hand Hygiene Collaborative is the first in the nation to measure compliance with protocols across a state hospital system using consistent scientific methodology. At least 45 of the 47 general acute care hospitals in the state have agreed to participate.

Starting January 1, the teams will start their secret monitoring. They will observe 30 caregivers exiting patient rooms per hospital unit per month and record what they saw on a small hand-held device or enter it in writing.

The results will be analyzed and reported, perhaps publicly. The idea is that at most hospitals, the observers will be hospital employees who usually work elsewhere in the facility.

"This isn't being designed as a 'gotcha,'" says Nicole Stallings, director of the Maryland Health Quality and Cost Council, one of the organizing agencies. No hospital employee caught forgetting hygiene practice will be penalized, she says.

Rather, "hospitals are really going to benefit because for the first time, everyone will see how they're doing relative to other hospitals in the state." They also will be able to "drill down internally" to see how compliance measures up on each floor and unit, she adds.

"If you ask providers if they wash their hands, 99% of the time they will say 'certainly,'" says Richard "Chip" Davis, vice president for Innovation and Patient Safety at Johns Hopkins Medicine. "But we know that when you observe their behavior, there's a pretty significant difference."

Many of the hospitals already observe versions of the "five points of hand hygiene protocol," which specifies the use of gel or hand-washing before touching a patient or starting a procedure. After a procedure, the protocol suggests the same washing before touching a patient or touching the patient's environment, Stallings says.

But it was decided that all the hospitals could agree to use one of those points—when a caregiver leaves a patient's room—so that the same practice would be compared. Hand hygiene on different levels of care, as well as care on different floors, can also be compared within a hospital.

The project is expected to last for at least one year, and has received $100,000 in federal stimulus funds through the state Department of Health and Mental Hygiene.

Davis says the secret shopper project is modeled after one that has been under way at Johns Hopkins for the last two years.

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