Glimmers of Hope for More Clean Hands
Over 150 years ago, the Austrian physician Ignac Semmelweis discovered that, by washing their hands regularly, doctors could stop the spread of disease between patients. Now, a century and a half later, hand-washing is a common practice – but not nearly common enough. Studies have shown that doctors wash their hands as little as 30% of the times they interact with patients. With the rise of nasty antibiotic-resistant germs, hand-washing is more important than ever. And now that hospitals can be financially impacted if their patients are infected while in their care, they are paying more attention to the need to prevent their occurrence.
That’s why many hospitals are opting to use new technology to encourage doctors to boost their compliance with hand hygiene requirements. A New York Times article details recent efforts by hospitals to implement surveillance mechanisms to track just how often doctors wash their hands. At North Shore University Hospital, located in Long Island, hospital administration installed cameras near hand-washing stations. Workers in India were tasked with keeping track of how often each staff member washed their hands, and then reporting this data back to the hospital. Other hospitals have outfitted doctors with Bluetooth enabled badges, which vibrate when a doctor is about to treat a patient without washing his or her hands beforehand.
So why aren’t doctors washing their hands? Studies offer an array of reasons: dry hands, pressures on time, or a resistance to authority. But with $30 billion spent each year on hospital-acquired infections and nearly 100,000 annual deaths, it’s hard to be sympathetic to a doctor’s dry skin or resistance to colleagues or patients asking them to wash their hands. The efforts outlined in the article are a promising start to addressing hand hygiene, but they may only be a first step. “People learn to game the system,” said Dr. Elaine Larson, a nursing professor at Columbia University specializing in hand-washing. “There was one system where the monitoring was waist high, and they learned to crawl under that. Or there are people who will swipe their badges and turn on the water, but not wash their hands. It’s just amazing.”
In order for substantial change to occur, medical culture must change as well. As Danielle Ofri writes in her recent New York Times op-ed, doctors are too often attuned to a culture of shame, in which doctors keep their errors quiet unless their consequences are obvious. Ofri admits to a “near-miss” she made in her medical residency: declaring a patient in good health when a radiologist detected a cranial bleed in the patient a few hours later. In the current hospital environment, Ofri found it too difficult to speak about the factors leading to her mistakes – and she’s not alone.
Hospital leadership must move in a direction where doctors feel comfortable engaging in a dialogue about their mistakes. These conversations may be uncomfortable, but they provide a crucial path to averting future mistakes and near-mistakes. The same principles can be applied to hand-washing – there must be a greater sense of openness about hand-washing and a better understanding of the concerns on both sides. If these new tracking mechanisms can be used to provide doctors specific feedback on their hand-washing, hospital culture should also allow doctors to provide hospital administration feedback on hand-washing infrastructure. If doctors have dry hands, perhaps doctors might request gel with aloe, for instance: a small cost compared to that of hospital-transmitted infections.
Patients deserve the confidence that their doctors are treating them with clean hands. Hospitals can provide a critical role in this by making sure noncompliance in hand hygiene is not only addressed, but also discussed.