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Tuesday, June 2, 2009

She has taken off her name tag: Hand-washing in hospitals

The WBUR radio station played a story this morning about hospitals' efforts to encourage staff to wash their hands frequently, to prevent hospital acquired infections.

At one Harvard teaching hospital, a nurse observes staff on the Cardiac unit to see who is washing their hands and when. What makes the nurse sure that they won't know they're being watched? Oh, she has taken off her name tag - but still wears the standard blue nurse's uniform and white coat. For ten minutes, she notes who washes their hands. Meanwhile, the Cardiac unit nurses hurry around the unit, probably aware of the one nurse, not from their unit, who isn't hustling around. Surprise! –everyone dutifully uses the hand sanitizer while she watches them. Does this spot-checking really raise compliance with hand-washing rules? Or does it just provide a reassuringly high rate of hand-washing?

A more reliable approach uses unobtrusive measures. Indeed, that ("Unobtrusive Measures") was the title of a book by Eugene Webb et al, written back in 1966. Such unobtrusive or “non-reactive” measures probably give a more honest view. At Beth Israel Deaconess Medical Center in Boston, for example, staff instead measure the volume of hand sanitizer used.

Advice to patient advocates: Bring a bottle of your own hand sanitizer, and keep it on the patient's bedside table as a gentle reminder.

Read another story on blue uniforms and hospital cleanliness.

Thanks to Sacha Pfeiffer for the source story on WBUR today.

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