Wash those hands...or else!

Originally posted 2-6-2011:
It's Super Bowl Sunday.  That means today is a big day for Packer and Steeler fans, or a fun day for commercial lovers.  Regardless, it provides an excuse to have a party.  Wings, pizza, chips and dip, cut up veggies...many of us will be eating all kinds of finger food goodies. But before you started digging in, did you remember to wash your hands?

This seems to be a common question being asked of clinicians these days. Hand hygiene, or a lack thereof, is considered one of the major contributors to the spreading of infections among patients in the hospital.  As a result, many different hospitals are coming up with different plans to improve hand hygiene compliance.

I came across two blogs this last week that described two very different ways to address the problem.  This blog from the ECRI Instititue site describes a series of hospitals in Ohio that achieved 95% compliance with education, staff monitoring, and the installation of additional hand sanitizer dispensers.  It sounds like the success stemmed from savvy systems improvements to ensure clinicians maintained compliance.  A different approach was described in this Controversies in Hospital Infection Prevention blog.  It appears that the University of Pittsburgh Medical Center is considering fining employees for not following hand hygiene compliance in response to an increase of infections. 

There definitely appears to be a "carrot" and a "stick" feel to these approaches.  I'll be curious to see if things improve at UPMC if the fines are levied.  This sort of punishment goes against a systems level solution where improvements are made to conditions around the clinician to make sure no harm reaches the patient. I have heard the argument that a fine system like this would be a wake up call to improve compliance.  I'm not sure I'm convinced.

What are your thoughts on this?  Is the threat of a fine an effective way to get you to wash your hands?