Saturday, October 16, 2010

Why don’t hospital workers wash their hands?

Nurse washing hands

Hand washing reduces hospital-acquired infections. How do you motivate hospitals to comply with standards? How do you measure compliance? Turns out this is not a simple problem, according to an article in The Journal of the American Medical Association.
Hospitals may have good reasons for selecting an auditing method that will overestimate compliance. For example, audits may be delayed on poorly performing units to allow time to implement quality improvement or auditors may inform health care workers they are being auditing (sic) because they believe it is unethical to monitor covertly. However, as the pressure to perform increases, organizations seeking rapid improvement will be more likely to maintain or substitute methods that overestimate compliance than to use methods that measure true (ie, worse) compliance because doing so would make their hospitals appear to be underperforming relative to their peers.
Public reporting of hand hygiene compliance places clinicians in a position in which they must choose between protecting patients by striving for real hand-hygiene improvement or protecting their reputations by reporting high rates of hand hygiene compliance. The first path is difficult and often unsuccessful. To encourage progress along this path, it would be better to avoid public reporting before evidence-based improvement strategies are implemented and direct resources toward identifying better ways of measuring and improving hand hygiene. [emphasis added]

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