The impact of hand hygiene on infections
Providers and other hospital workers who don't participate in hand hygiene could contribute to infections and poor patient outcomes and even deaths, Gene Burke, Sentara vice president and executive medical director of clinical effectiveness, told FierceHealthcare. In fact, people in public restrooms are more likely to wash their hands than in hospitals--a shocking (and gross) reality, based on a 2010 study from the American Society of Microbiology and the American Cleaning Institute.

What causes this friendly fire of providing care? It's a mix of a hospital churning out care and providers being in a rush.

"The industry of healthcare in this country has become a production industry. We are like the U.S. automobile industry in the 70s. We have been more concerned with cranking out more units of care, rather than attending to the quality of care," Burke said. He continued, "What we're seeing the in noncompliance of hand hygiene is that if you're always rushing to get more work out of a day--and I propose most doctors and nurses are doing--little things that aren't glaringly necessary drop off. Hand hygiene is one of those things that people aren't making a deliberate decision to not do it; it's that it takes time."

Discovering misleading compliance rates
Sentara reengineered its audit process. Before testing, the hospital system thought compliance was at 95 percent; it turns out it was more like 77 percent. Hundreds of front-line employees at eight hospitals brainstormed and came up with 364 ideas about what could improve hand hygiene compliance. From those, they tested 21 factors that were practical, fast, safe and--perhaps the most appealing part--cost-free. They had two rounds of testing, coming up with recipes, that is, combinations of methods that might help health workers to use wipes, use sanitizer foam or wash their hands with soap and water.