Faced with lacklustre compliance
rates for physician handwashing, California hospital
administrators tried every trick in the book to get
doctors on board.
The Los Angeles-based Cedars-Sinai
Medical Center started with the least invasive intervention:
occasional education sessions, hand sanitizing gel dispensers
outside hospital rooms and in doctors' pockets, and
measurement and feedback. A small improvement was observed,
but the administration wasn't ready to quit yet.
The next step was to try to embarrass
the doctors. Twenty staff physicians were corralled
at a lunch meeting and cultures of their hands were
taken. The results were put on display at their next
meeting. They were reportedly ashamed, but handwashing
rates didn't rise.
Next, they raised "Hand Hygiene
Posses" to bully and threaten doctors to improve. The
posses, composed of hospital executives and department
chairs, roamed the halls of Cedars-Sinai to enforce
the hospital's hand hygiene regulations. Doctors who
were caught flouting the rules were reprimanded and
warned they could have their hospital privileges suspended;
those who were seen washing up were rewarded with Starbucks
gift certificates. The strategy raised the compliance
rate among doctors from a dismal 50% to 70%, but still
the administrators weren't satisfied.
Eventually, study author Dr Rekha
Murthy told an audience at the Infectious Diseases Society
of America in early October, hospital officials resorted
to a last-ditch effort: they suspended one physician.
News of the suspension spread like wildfire among the
hospital's 2,000-odd doctors and the hand washing compliance
rate quickly jumped up to nearly 90%. This was still
short of the spic-and-span nurses' over-90% rate, but
an unprecedented improvement nevertheless.
Over the course of the entire series
of interventions, Dr Murthy said, the hospital's MRSA
infection rate dropped to half what it had been, at
a time when Los Angeles was suffering from several outbreaks
of the disease.
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