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Breakthrough performance in hand washing

Medical Staff Leader Connection, September 16, 2009

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Dear Colleague,

It’s no mystery that the single most effective tool for preventing nosocomial infections is effective hand washing and hand sanitizing. However, healthcare workers in general (physicians in particular) have an abysmal track record of carrying out the simple yet critical act.

Nosocomial infections, including MRSA, C. difficile, and vancomycin-resistant enterococcus, cause tens of thousands of preventable patient deaths in hospitals every year and cost the healthcare industry billions. Some nosocomial infections have become “never events,” for which the Centers of Medicare and Medicaid Services will no longer reimburse. In addition, The Joint Commission will be paying more attention to safety measures, such as hand washing, with the development of The Center for Transforming Healthcare announced late last week.

John Saunders, MD , an ear-nose-throat surgeon and chief of staff at Greater Baltimore Medical Center (GBMC), decided to tackle this challenge by getting personal. He and the team at GBMC asked every individual who provides patient care, including physicians and nurses, to take a pledge. This involves individuals signing a document acknowledging their commitment to wash their hands or use hand sanitizers.

The genius of this approach is that Saunders and his team posted every single pledge on the walls of various units where the individuals who made the pledge work frequently. This makes everyone’s commitment public, but it’s not just part of the wallpaper—the documents on the wall remind everyone of their commitment to hand washing and hand sanitizing.

This simple step, along with the usual education, measurement, feedback, and counseling has achieved exceptional results. In his electronic newsletter to the medical staff, Saunders reported in July that the physicians washed their hands more frequently than the nurses. This was radical enough in itself, but the compliance numbers for the physicians and nurses are almost unheard of:  97.2% for physicians and 95% for RNs.

These statistics were documented by secret snoopers who measured compliance with hand washing/sanitizing without anyone else knowing. In fact, when you throw in the LPNs, techs, and ancillary services providers, the institution-wide hand washing/sanitizing rate was an unbelievable 96.4%! I know of no other hospital that even comes close to this level of performance.

I hope you can all find a way to institute a hand washing/sanitizing pledge program at your hospital. If you have such a program or if you have any other strategies that have worked to improve hand washing/sanitizing rates, I’d love to hear about your successes so we can share them with others. Please email me at rsheff@greeley.com to let me know what your facility is doing.

Rick Sheff, MD, CMSL, is chairman and executive director at The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.

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