Hands Clean

On April 25, part of the cafeteria at Penn State Milton S. Hershey Medical Center was transformed into a nightclub complete with velvet ropes, music and food. But instead of paying some exorbitant cover charge to get in, all employees had to do was show up with clean hands.

The event was part of the center's Club Clean campaign. The Dauphin County hospital started Club Clean in November to educate employees about the importance of keeping their hands clean. A couple of months ago, the Derry Township hospital launched a monitoring program to make sure workers follow hand-hygiene policies.

Programs such as Club Clean are becoming more common as hospitals step up efforts to improve employees' compliance with policies requiring workers to wash their hands and use alcohol-based hand sanitizers. Representatives of several Central Pennsylvania hospitals agreed that keeping employees' hands clean is the most effective way to reduce incidences of hospital-acquired infections. Pennsylvania hospitals identified 13,711 hospital-acquired infections during the first nine months of 2005, according to the Harrisburg-based Pennsylvania Health Care Cost Containment Council. Those infections were associated with 1,456 deaths and 227,000 extra hospital days.

"The benefits that you get out of (hand hygiene) are huge," said Lynda Martin, Hershey Medical Center's director of clinical quality management and performance improvement.

The Cambridge, Mass.-based Institute for Healthcare Improvement partnered with the federal Centers for Disease Control and Prevention and other health-care groups to create a guide to help hospitals improve hand hygiene. The guide, released in April, is the groups' response to reports that many heal healthcare employees don't clean their hands as often as they should. Compliance rates are below 50 percent at some hospitals, according to the guide.

Through the Club Clean education effort, buttons have been given to employees, and posters have been plastered throughout Hershey Medical Center and Penn State College of Medicine. Restroom posters feature images of hands pointing to a sink with the message "Next Stop on Your VIP Tour of the Restroom." Another poster encourages patients at the Penn State Children's Hospital to "Wash your paws and join the club!"

Giving employees a fun way to learn about hand hygiene makes it less likely that the hospital will have to discipline anyone for not complying with policies, Martin said. The medical center's monitoring process includes hospital staff observing employees to see if they clean their hands often enough.

"We wanted to get everybody on board and know what the expectations are before we started the monitoring," she said.

Holy Spirit Hospital in East Pennsboro Township also monitors its employees' hand-hygiene habits, habits, said Candy Shugars, manager of infection control at the Cumberland County hospital. The hospital tracks the amount of soap and alcohol-based hand sanitizer used on each floor, too.

Like Hershey Medical Center, Holy Spirit partners its monitoring efforts with education. Periodically, employees are asked to use a special lotion on their hands. A black light illuminates all the dirt they can't see.

"It lets people know, 'Man, I missed A of that?'" Shugars said. "I don't think anyone can say they haven't been educated on hand washing." Workers who habitually fail to comply with the hospital's policy can be disciplined, although Shugars did not know of anyone who was fired for not keeping their hands clean.

Education is key because many employees fail to comply with handhygiene policies out of ignorance and not malevolence, said Mary Ellen Meneeley, an infection-control program director at York-based WellSpan Health. It runs York Hospital.

"I really believe there's not intentional neglect of hand hygiene," she said.

A challenge for many hospitals is to figure out how to best encourage employees to intervene when they see other workers not following hand-hygiene policies. Holy Spirit Hospital has a team of aides, nurses and other workers who serve as "infection-control deputies." WellSpan Health encourages employees to talk to managers or infection-control staff if they witness repeated violations and don't want to confront the offending workers.

One goal of Club Clean is to empower employees to remind other workers of the policies, no matter their position in the organization. A member of the housekeeping staff should feel comfortable telling a doctor to wash his or her hands, Martin said.

"We want everybody to serve as checks and balances for the organization," she said.

Patients are more aware of the importance of clean hands, as well. Hospital administrators notice more patients asking about hand hygiene. Many organizations include information about the topic in their admissions packets.

"From what I'm hearing, more patients are advocating for their own safety," Meneeley said.