First line of defense: UPMC is right to fine staff for not washing hands
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In the world of modern health care, the simple act of hand washing is widely recognized as the most important way to reduce infections in health care facilities. Nonetheless, persuading employees to comply 100 percent of the time remains an elusive goal.
Hospitals have tried all sorts of approaches to washing hands and cleaning medical equipment and wearing gloves and gowns where necessary. Educational programs. Marketing campaigns. Introduction of alcohol-based hand wash, placed throughout the building. Posted reminders. Some facilities have utilized employees as spies to get accurate information about the behavior of their colleagues.
The University of Pittsburgh Medical Center, likewise, has used encouragement, education, gift cards and other methods. Now, UPMC Presbyterian is taking aim at employees' wallets due to a jump in infections by antibiotic-resistant bacteria. Administrators said they will fine doctors $1,000 ($250 for residents and fellows) and send other workers home for a day without pay if they ignore the rules in areas where infected patients are confined. Eventually, a more stringent accountability program may be implemented throughout the health system.
Presby is not the first hospital to use money as motivation. Two years ago, Texas Children's Hospital in Houston launched "Hy-Five," a campaign aimed at patients, families and employees. Although that boosted compliance to 80 percent and earned the hospital the Child Health Corporation of America's National Quality Award, Texas Children's wanted to do better.
First it made hygiene a component of the employee bonus program, and then it linked hand washing to the administrators' bonuses, too. The hospital as a whole had to meet a 95 percent rate of compliance or part of the bonuses would not be issued. Since starting the program, compliance has stayed between 95 and 99 percent.
This is no small matter. Hospital-acquired infections threaten patients' safety and health, and they drive up the cost of treatment. For example, the Pennsylvania Health Care Cost Containment Council's most recent report on hospital-acquired infections in the state shows significant differences between patients with and without such infections - mortality rates of 12.2 percent versus 2 percent; length of hospital stays of 19.7 days versus 4.4 days, and an average hospital charge of $191,872 versus $35,168.
Taking 30 seconds to wash before treating every patient won't prevent all hospital-acquired infections, but it's worth the minimal time and effort. UPMC has made the right call in deciding to penalize employees who don't.
First Published February 7, 2011 12:00 am
