How do you make doctors wash their hands?

The New York Times blog Fixes has a pair of posts about the design challenge of getting doctors to wash their hands. Here’s part one and part two.

A health care worker’s hands are the main route infections take to move from one patient to another. One recent study of several intensive care units — where the patients most vulnerable to infection reside — showed that hands were washed on only one quarter of the necessary occasions.

It’s not that hospitals are ignoring the problem — indeed, they are implementing all kinds of strategies to promote hand-washing. Nevertheless, it is rare to find a hospital that has been able to keep the hand-washing rate above 50 percent.

Medical staff are busy, and in many circumstances they may be required to wash their hands dozens and dozens of times a day. But hand-washing is the only way to combat infection. And even though they certainly know it’s important, medical staff are simply not doing what they need to do to prevent infection.

To combat this problem, there is a whole new generation of high-tech devices aimed at making doctors wash their hands:

They work like this: every health care worker wears an electronic badge. When she washes her hands or uses alcohol rub, a sensor at the sink or dispenser or her own badge smells the alcohol and registers that she has washed her hands. Another sensor near the patient detects when her badge enters a room or the perimeter around a patient that the hospital sets. If that badge shows that her hands were recently washed, it displays a green light or something else the patient can see. If she hasn’t washed, her hands, the badge says so and emits a signal to remind her to do so. The sensor also sends this information to a central data base. Information about the hand-washing practices of a particular unit, shift or individual is instantly available.

But there may be a much lower-tech solution: the checklist. Through mandatory use of a checklist, hospitals in Michigan have been able to almost completely eradicate line infections (infections at the point of a intravenous needle). As Fixes notes, the list not only reminds medical staff of the steps they needed to take, but empowers everyone on the team to stop someone else if they skip a step.

Journalist/surgeon Atul Gawande wrote an excellent piece on the use of checklists in medicine in the New Yorker that is definitely worth reading.

Fixes is correct in noting that a checklist is overkill for a process that only has one step. But any solution to the problem of infection will likely need to take into account behavioral aspects of the problem, especially given costly, high-tech hand-washing alert systems are simply not feasible for a great many of the world’s hospitals.

Fixes – Better Hand-Washing Through Technology
Fixes – Speaking Up for Patient Safety, and Survival
New Yorker – The Checklist

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