You wouldn't think that we'd have to devote a lot of time, attention and effort to getting people to wash their hands, would you? It's pretty straight forward. Efficient hand washing is probably the least expensive and certainly one of the most effective patient safety interventions to prevent hospital-acquired infections.
Yet, hand-washing results across hospitals and other healthcare organizations are routinely dismal. At St. Mary's Hospital in Madison, Wisc., we were right there. A few years ago, our compliance of staff and physicians using accepted hand-washing protocol before and after patient contact was only 76 percent, ranking us near the bottom of all hospitals in our SSM Health Care system.
Needless to say, when these results were shared we were distressed, as these numbers were significantly out of line with our other patient safety indicators. So we utilized our SSM Health Care culture of continuous improvement to get better.
We first did our research. We looked at organizations that had achieved success in hand washing, not just in SSM Health Care but outside. For example, Novant Health, headquartered in North Carolina, achieved 99 percent hand-hygiene compliance and 63 percent reduced methicillin-resistant Staphylococcus aureus (MRSA) infections through a creative, comprehensive campaign. Novant generously made its campaign materials downloadable for free at WashingHandsSavesLives.org to any organization.
All departments at St. Mary's Hospital designated hand-washing champions who met monthly at first, and less often as the process progressed. I personally became the Administration champion. Through our SSMHC planning process, each department established hand-washing goals aligned with our organizational goals. Monthly progress based on agreed-upon measures was recorded on prominently displayed departmental goal posters. Lastly, each individual employee at St. Mary's was required to have a personal hand-washing goal documented on his/her Passport, the personalized goals tool we provide to each staff member.
One of the biggest barriers we faced was our "Midwestern politeness," where we were reluctant to correct each other if we observed less-than-optimal hand washing. This was particularly true with physicians. An unsuccessful attempt to address this was to have people submit names of those who needed reminders; each would then receive a letter signed by me. That proved completely ineffective at doing anything but angering the recipients, one of whom commented, "I wish someone would have told me when they saw me rather than me getting this letter from you six weeks later."
It's too early to declare victory but our results have improved dramatically. We went from 76 percent compliance to more than 90 percent for the last twelve months, and as high as 97 percent for two months. Simultaneously, we experienced a statistically significant reduction in healthcare onset-MRSA, from 0.362 per 1000 patient days to 0.194 per 1000 patient days (p=0.003).
Given these great results, we also took care to celebrate our successes and the hard work of those who brought us to this point. For example, we provided each of our department champions with logowear embroidered with "St. Mary's Hand Hygiene Champion."
All of our efforts continue, plus we're adding more all the time--the latest of which is a contest encouraging staff to develop videos and/or posters on hand washing. We are not letting up.
Hand washing--it's a simple but important act. Yet we believe that it has dramatically contributed to helping us fulfill our commitment of providing a safe environment for those we are privileged to serve.
Frank D. Byrne, M.D., is the president of St. Mary's Hospital in Madison, Wisc.