When observed by humans, medical personal take note and wash their hands more scrupulously than when observed by electronic cameras. The fix? Not more human monitoring, but more immediate feedback to the medical personnel.
Hospitals do impossible things like heart surgery on a fetus, but they are apparently stymied by the task of getting health care workers to wash their hands. Most hospitals report compliance of around 40 percent — and that’s using a far more lax measure than North Shore uses. I.C.U.’s, where health care workers are the most harried, usually have the lowest rates — between 30 and 40 percent. But these are the places where patients are the sickest and most endangered by infection.
How do hospitals even know their rates? Some hospitals track how much soap and alcohol gel gets used — a very rough measure. The current standard of care is to send around the hospital equivalent of secret shoppers — staff members who secretly observe their colleagues and record whether they wash their hands. This has serious drawbacks: it is expensive and the results are distorted if health care workers figure out they’re being observed. One reason the North Shore staff was so shocked by the 6.5 percent hand-washing rate the video cameras found was that measured by the secret shoppers, the rate was 60 percent.
What makes the system function is not the videotaping alone — it’s the feedback. The nurse manager gets an e-mail message three hours into the shift with detailed information about hand hygiene rates, and again at the end. The L.E.D. signs are a constant presence in both the surgical and medical I.C.U.s. “They look at the rates,” said Isabel Law, nurse manager of the surgical I.C.U.. “It becomes a positive competition. Seeing “Great Shift!!” is important. It’s human nature that we all want to do well. Now we have a picture to see how we’re doing.”