Why don’t hospital workers wash their hands?

Hand washing reduces hospital-acquired infections. How do you motivate hospitals to comply with standards? How do you measure compliance? Turns out this is not a simple problem, according to an article in The Journal of the American Medical Association.

Hospitals may have good reasons for selecting an auditing method that will overestimate compliance. For example, audits may be delayed on poorly performing units to allow time to implement quality improvement or auditors may inform health care workers they are being auditing (sic) because they believe it is unethical to monitor covertly. However, as the pressure to perform increases, organizations seeking rapid improvement will be more likely to maintain or substitute methods that overestimate compliance than to use methods that measure true (ie, worse) compliance because doing so would make their hospitals appear to be underperforming relative to their peers. …

Public reporting of hand hygiene compliance places clinicians in a position in which they must choose between protecting patients by striving for real hand-hygiene improvement or protecting their reputations by reporting high rates of hand hygiene compliance. The first path is difficult and often unsuccessful. To encourage progress along this path, it would be better to avoid public reporting before evidence-based improvement strategies are implemented and direct resources toward identifying better ways of measuring and improving hand hygiene. [emphasis added]

Am I missing something here or does this say we shouldn’t publicize information about hospitals with poor hygiene because they’ll just lie about the facts or be otherwise devious and dishonest? Plus, reputation – that is, the financial profits of medicine – is more important than the health and safety of patients? No, it couldn’t be saying that. Or maybe it is, and we should at least be grateful that someone has the courage to speak honestly in public.

Here’s more than you probably want to know (from the CDC) about the hand-hygiene of health care workers. I’d been wondering: Is the problem that it takes too much time – like scrubbing for surgery? According to the CDC, the observed times for hand washing were between 6.6 and 24.0 seconds. Which only tells me that — currently — it doesn’t take much time at all.

Resources:

Image source: John Cook Wyllie Library

Matthew P. Muller, MD, PhD; Allan S. Detsky, MD, PhD, Public Reporting of Hospital Hand Hygiene Compliance — Helpful or Harmful?, The Journal of the American Medical Association, September 8, 2010, vol. 304 no 10, pp 1116-1117