Do Hospital Workers Really Wash Their Hands?


November 15, 2013

One of the easiest ways for bacteria to spread is through unwashed hands. That’s true even for drug-resistant bacteria — a threat the Centers for Disease Control (CDC) has dubbed a “nightmare.”

In Hunting the Nightmare Bacteria, FRONTLINE found that some of these strains thrive in hospitals, preying on vulnerable patients, which means that preventing transmission there is even more important.

Hospitals typically take precautions to sanitize rooms and equipment. And in addition to washing hands after any personal business, health-care providers are supposed to wash their hands before and after interacting with a patient, and before they enter and leave each room where they work.

Six years ago, one hospital decided to investigate whether its staff members really washed their hands as often as they should. Like most hospitals, the University of Arizona Medical Center reported that staff members washed their hands about 90 percent of the time, relying on data reported by each unit in the hospital.

But “there was a disconnect between what the reported numbers were, and what our anecdotal experience was,” said Dr. Sean Elliott, the center’s medical director of infection prevention. “We heard from other individuals, ‘Geez, nobody seems to wash their hands.’”

So Elliott started a “secret shopper” campaign to get some real data. At first it was informal. He sent out administrative assistants to roam the halls and observe how often people actually washed their hands.

What they found: compliance only averaged around 50 percent — with some instances as low as 30 percent. Granted, the nurses were better than the doctors, by about 5 or 10 percentage points. But neither rated very highly.

“We started pretty darn low, and it was embarrassing, as you could imagine,” Elliott said.

There was plenty of resistance to improving, he said. Some surgeons said they couldn’t be part of the problem because they spent so much time in the operating room. Other staff members said it wasn’t convenient to wash up so often, despite the many alcohol-based hand-washing stations throughout the hospital.

And some, Elliott said, just didn’t realize they had to wash their hands before and after they interacted with each patient, or moved from room to room.

So two years ago, the hospital expanded its campaign, creating posters featuring physician and nursing leadership from each unit declaring that they supported good hand hygiene.

The aim was partly a guilt-trip, “to just kinda put people in a tight spot,” Elliott said. For example, he said, “The chief of a certain unit was known for not washing his hands.” So they splashed his picture on a poster declaring his support for the policy to encourage him, and everyone in his unit, to wash their hands. “That person started washing his hands,” he said.

The hospital singled out stars, too, awarding staff noted to be regular hand-washers by putting their images on posters as “Hand Hygiene Champions of the Month.” And they ramped up the competition to award whole units for washing their hands regularly, which Elliott said helped to strengthen a culture of compliance.

The hospital is also creating videos on hand-washing and designing screen savers for network computers that show up-close images of a bacteria carnival on an unwashed hand.

Since the expanded campaign began, Elliot said the the University of Arizona Medical Center has increased its hand-washing compliance by 30 to 40 percentage points, according to his secret-shopping data.

“The hospitals doing proper surveillance are not reporting 90 percent compliance,” he said. “We have to own it so we can fix the problem.”

Sarah Childress

Sarah Childress, Former Series Senior Editor, FRONTLINE

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