Roughly five years ago Rhode Island Hospital in Providence had a hand hygiene problem. Only 40-50 percent of all hand washing that was supposed to take place was actually happening, and, as a result, the entire institution decided to institute a major hand hygiene initiative. Today, hand washing compliance reaches 90 percent and above and has topped 99-100 percent in many months, according to John Murphy, MD, senior vice president of medical affairs and CMO at Rhode Island Hospital in Providence.
So how did it manage this significant improvement? It required a serious commitment by the hospital, support from senior leadership and a number of large and small changes by physicians and staff.
First, the hospital knew it had to find a way to obtain data on hand washing compliance. After all, what is not measured cannot be improved. To do this, light duty nurses across all shifts, including nights and weekends, were asked to serve as "secret shoppers" — secretly observing hand washing compliance and keeping track of instances of compliance versus noncompliance.
The hospital's clinical leadership also held a number of focus groups with staff and patients to identify what the impediments were to hand washing. One of the more unique barriers identified was a fire marshal regulation that no alcohol-containing substances was allowed to be stored in patient care rooms in Rhode Island. The rule may seem benign on the surface, but it actually prohibited the hospital from storing or providing the antibacterial foam clinicians use to wash their hands in patient rooms. "We actually worked to get the law changed to make it more likely clinicians were foaming out every single time," says Dr. Murphy.
The hospital also began a marketing campaign of sorts to promote hand washing. It created roughly 250 posters, hung throughout the hospital, featuring 3-foot "mug shots," as Dr. Murphy explains, of him using the foam dispenser to wash his hands. The chief of surgery, chief nursing officer and others were also featured. The campaign promoted hand washing and raised Dr. Murphy's visibility as a champion of hand-hygiene compliance. "Every single patient and their family knew who I was," he says. "The larger across-the-board initiative got us to not only be complaint and really changed the culture."
That culture became apparent to Dr. Murphy when he observed the following scenario. A physician leader in one of the hospital's surgical subspecialties — someone Dr. Murphy refers to as a "high profile individual" — was making rounds with half a dozen residents and medical students in tow, when one of the nurses noticed he forgot to wash his hands when he left a patient room. She immediately alerted him, and he responded by thanking her, explaining she did the right thing. He also used the situation as a teaching example to the students of the importance of compliance. "It speaks to the change in the culture we have in this institution," said Dr. Murphy. "The same thing wouldn't have happened 10 or 12 years ago."
So how did it manage this significant improvement? It required a serious commitment by the hospital, support from senior leadership and a number of large and small changes by physicians and staff.
First, the hospital knew it had to find a way to obtain data on hand washing compliance. After all, what is not measured cannot be improved. To do this, light duty nurses across all shifts, including nights and weekends, were asked to serve as "secret shoppers" — secretly observing hand washing compliance and keeping track of instances of compliance versus noncompliance.
The hospital's clinical leadership also held a number of focus groups with staff and patients to identify what the impediments were to hand washing. One of the more unique barriers identified was a fire marshal regulation that no alcohol-containing substances was allowed to be stored in patient care rooms in Rhode Island. The rule may seem benign on the surface, but it actually prohibited the hospital from storing or providing the antibacterial foam clinicians use to wash their hands in patient rooms. "We actually worked to get the law changed to make it more likely clinicians were foaming out every single time," says Dr. Murphy.
The hospital also began a marketing campaign of sorts to promote hand washing. It created roughly 250 posters, hung throughout the hospital, featuring 3-foot "mug shots," as Dr. Murphy explains, of him using the foam dispenser to wash his hands. The chief of surgery, chief nursing officer and others were also featured. The campaign promoted hand washing and raised Dr. Murphy's visibility as a champion of hand-hygiene compliance. "Every single patient and their family knew who I was," he says. "The larger across-the-board initiative got us to not only be complaint and really changed the culture."
That culture became apparent to Dr. Murphy when he observed the following scenario. A physician leader in one of the hospital's surgical subspecialties — someone Dr. Murphy refers to as a "high profile individual" — was making rounds with half a dozen residents and medical students in tow, when one of the nurses noticed he forgot to wash his hands when he left a patient room. She immediately alerted him, and he responded by thanking her, explaining she did the right thing. He also used the situation as a teaching example to the students of the importance of compliance. "It speaks to the change in the culture we have in this institution," said Dr. Murphy. "The same thing wouldn't have happened 10 or 12 years ago."
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