DN: For the hospitals that worked with this, what are some of the recommendations that come out of the solution?

MD: What we found was there are about 14 different reasons why people don't wash their hands, ranging from distraction to the hand sanitizer dispensers being empty to wearing gloves instead of washing your hands. Another problem was "follow the leader:" I'm walking with you into a room and you don't wash your hands, so I'm not going to wash my hands either.


Each organization measures those things so they would be able to figure out the most common causes of failure within their pilot areas. Once those were identified, they created the solutions and tested them and were found to have rigor as far as impacting those causes and resulting in improved hand hygiene compliance.

For instance, if someone's walking into a room with their hands full of supplies, they can forget to wash their hands. So, you create a drop spot: you designate a spot in the room that is considered for medical-use only, where those items can be set down. Patients and family members have to be educated that they leave that area clear for health care workers. So now they have a space to set down supplies, and within arms' reach is an alcohol-based hand sanitizer dispenser.

DN: How many hospitals are participating in it today?

MD: After the eight hospitals did their work, then we actually piloted it in 27 different organizations. They ranged in size form large academic medical centers down to 25-bed critical access hospitals. They're demonstrating improvements. Now we have folks starting to use the tools, and many are rolling this out to their entire organization.

DN: The project started with hospitals with a lot of resources like Memorial Hermann in Texas and Johns Hopkins. Do you think the results are transferable to smaller hospitals?

We think it will be really good for smaller organizations...We have a downloadable, self-supporting, training module for the data collection tool. It has a test that staff can take: we've given them posters and other support that they can download and use. If you're a staff nurse on a unit, there's no way you'd have the resources to do that on your own. I think it's really geared toward the smaller organization that lacks resources because you have this whole program ready to go: all they have to do is do it.

DN: Does choosing some staff to be observers who report hand hygiene performance create any hostility or mistrust among the staff?

MD: When staff see you going out and implementing solutions to now make it easier for them to wash their hands, it takes the stigma off. It becomes an "ah-ha moment," it's like they really do understand, that this is hard. You know: over time, you'll see the whole culture change. Now, they're not just washing their hands more, they're cleaning equipment in patient rooms that they hadn't done before because now they start getting it. Most places when they have done a "hand hygiene" project, it has all been about collecting the Yes or No's - did you wash your hands? And it's all been trying to lead by intimidation. But this is different.

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