HAI prevention article:

York, Memorial, Gettysburg hospitals on lookout for cleaner doctors' hands

Doctors don't always wash hands when they should. Hospitals are figuring out creative ways to make sure they do.

By BILL LANDAUER
Daily Record/Sunday News

Updated:02/03/2011 11:33:55 PM EST

There are Purell hand sanitizers at the room door of every patient in the pediatric department of York Hospital so doctors like Dr. Rakesh Patel can use them before seeing patients. Some hospitals are cracking down on health care professionals who don t clean their hands as often as they should. (Daily Record/Sunday News -- Jason Plotkin)

York, PA - They roam hallways at York Hospital, under cover.

They've been taught to watch hand and finger movements for the first signs of trouble.

Call them disinfectant detectives.

Their mission: making sure your doctor scrubs properly.

The hospital didn't hire Dog the Bounty Hunter to track hand-washing violators. But they're serious. If medical staffers don't follow proper hand-washing procedures, serious infections could result.

Think doctors wash when they're supposed to? At an average U.S. hospital, proper hand hygiene is performed only about 50 percent of the time, said Dr. Charles Chodroff, senior vice president and chief clinical officer at York Hospital.

Some hospitals are cracking down. Officials at UPMC Presbyterian hospital in Pittsburgh said this week doctors could face fines up to $1,000 if they don't wash their hands in an effort to combat an antibiotic-resistant bacteria that infected at least five patients last month.

Proper hand hygiene for medical staffers doesn't mean just soaping up before surgery. Every time doctors touch a piece of equipment or a patient, they're supposed to spend a few seconds with a bottle of hand sanitizer or at a sink with some soap, which can be a painstaking process, Chodroff said.

"Many hospitals have been trying to improve hand-hygiene rates. ... There's no way of knowing how many infections this would cut down," Chodroff said. "Even if it's one, it's worth it."

York Hospital had been asking doctors how well they comply with hand hygiene guidelines for years, Chodroff said. The medical staff told surveyors that they complied about 95 percent of the time.

Enter the disinfectant detectives. To verify their staff's hand habits, the hospital hired trained observers -- secret shoppers, Chodroff calls them -- to keep an eye on doctors to see how often they keep their hands germ free.

They found that York Hospital was closer to the national 50 percent compliance average, Chodroff said.

In July, the hospital launched a hand-hygiene campaign. It hasn't chosen to penalize medical staffers. York Hospital and all of WellSpan have instead tried to make it more fun, and focus on peer-to-peer interaction.

In January, for example, 19 doctors from York and Gettysburg hospitals volunteered for the Catch Me if You Can program. If staffers catch a doctor not washing as he or she should, they can win a gas card.

York Hospital found that after a month, its rates improved. A recent screening of the hospital found that compliance rates are up to 90 percent, Chodroff said.

Diana Scheide, manager of infection prevention and control at Memorial Hospital in Spring Garden Township, said compliance rates have ranged from 60 percent to 80 percent.

Like York Hospital, Memorial puts dispensers of hand sanitizer in patients' rooms and other key locations. Officials have also tried to promote clean hands with internal ad campaigns.

For example, one program involved taking samples from the hands of doctors who gathered for a convention and putting them in petri dishes to watch what bacteria would grow. Once a good-sized crop of the tiny organisms had grown in a few, photos were taken. The photos wound up on posters in the hospital's dining room as a reminder: This is what could grow inside your patients if you don't keep clean.

"We heard a lot of conversation generated from" the program, Scheide said.

When they should wash

The World Health Organization says there are five moments when doctors should clean their hands:

---before touching a patient

---before aseptic, or sterile, procedures

---after being exposed to a patient's body fluids

---after touching a patient

---after touching the patient's surroundings

More sanitizer, please

Every time doctors touch a piece of equipment, they should use a sanitizing solution on their hands.

Trouble is, it's not always handy, said Dr. Charles Chodroff, senior vice president and chief clinical officer at York Hospital.

For example, Chodroff would like to see hand sanitizer dispensers attached to every IV bag station.

That'll call for some innovation, however, since to Chodroff's knowledge no such product exists. So, the hospital has contacted a sanitizer company to see if such a product could be manufactured.

Hand washing "needs to become engrained as a habit," Chodroff said. "It needs to feel unnatural not to do it."

Catch me if you can

Gettysburg Hospital and York Hospital's Catch Me if You Can program involves 19 WellSpan doctors. If a staffer catches one of them failing to properly wash up, the doctor gives his arresting officer a card. The staffer can take the card to a hospital administrator, who puts the employee's name into a drawing for a free gas card.

Here are the doctors:

York Hospital

---Todd Butz

---Keith Clancy

---Stephen Dilts

---Sandra Fortna

---Lawrence Gaetano

---Priyesh Kurup

---Lee Maddox

---Kevin Morrison

---Robert Nash

---Rakesh Patel

---Seth Quartey

---George Robinson

---Heather Rumsey

---Sharon Scott

---Tom Scott

Gettysburg Hospital

---David Doud

---Benjamin Frizner

---William Steinour

---Adam Wasserman