Hospital punishes poor hand-washing with a pink slip

Employees with patient care responsibilities at Abingdon (Pa.) Memorial Hospital could soon find themselves out of a job if they don't follow hospital policy on hand-washing. This twist is the hospital's latest salvo in a two-year campaign to address poor hand-washing among employees who are involved in patient care.

The hospital's policy states that these employees must wash their hands before and after entering each patient's room. Two years ago Abingdon Memorial tasked an infection-control nurse in epidemiology with forming a team of spies to determine how often doctors and nurses complied with the policy.

The spies document the number of times hospital staff wash with soap and water or use hand sanitizers, conducting between 800 and 1,400 observations per month. Staff members who wash their hands only entering or leaving a patient room (not both) are counted as noncompliant. In December 2007, hand-washing compliance stood at only 31 percent, with physicians among the least compliant.

Abingdon Memorial's director of epidemiology spent time educating chronic offenders. In addition, the hospital put graphic screen savers on every computer to promote hand-washing and located sanitizer dispensers outside of every room.

Several months of effort boosted compliance to roughly 60 percent. At that point, John Kelly, the hospital's chief of staff, received permission to tell a patient's story. In April 2009, a 77-year-old patient died following 20 surgeries and hospitalizations over the previous four years--all the result of acquiring a MRSA (methicillin-resistant Staphylococcus aureus) infection during a stay at Abingdon Memorial for knee replacement surgery.

The patient "almost certainly" acquired MRSA "on the hands of someone in the hospital," says Kelly, who developed a slide show to put a personal face on the dangers of noncompliance and promote staff buy-in. Kelly first presented the show at management meetings, but then expanded to physician staff meetings, all departmental meetings and finally all new employee orientations.

By September 2009, compliance had risen to 88 percent. The hospital has experienced a "commensurate decrease in infections," says Kelly. "We have had dramatic reductions in central-line-related bloodstream infections, ventilator-associated pneumonias and surgical-site infections."

However, hand-washing compliance recently plateaued again, this time at around 80 percent. So this month Abingdon Memorial will institute a system of potential rewards, and punishments. Compliant hand-washers identified by the spy team will receive index cards that make them eligible for a prize raffle. Noncompliant employees will receive index cards with an infraction notice. Staff members who reach three infractions will receive a letter noting that reappointment is conditional. (The hospital reappoints employees every two years.)

Poor hand-washing could result in dismissal, says Kelly. "What's more serious than somebody dying from a hospital-acquired infection you could prevent?"

To learn more about the hospital's initiative:
- read the Philadelphia Inquirer article