With all the reminders lately to wash your hands to prevent the spread of flu, you might feel like you’re back in grade school. But it can be so hard to get people to follow proper hand hygiene that even many doctors and nurses don’t do it correctly.
That contributes to 1.7 million hospital-acquired infections each year. So several Boston hospitals have launched hand-washing campaigns, including some that involve rap music videos and undercover surveillance.
Everywhere you look at Massachusetts General Hospital, there seems to be a dispenser of hand sanitizer. They’re next to ATM machines. They’re in elevator lobbies. They’re inside and outside patient rooms.
“There are literally thousands of dispensers in this hospital,” says Judy Tarselli, a nurse at Mass General. “Literally.”
Tarselli is also — an undercover agent. Her job? To make sure the hospital’s staff is actually using these thousands of sanitizers.
Tarselli rides the elevator to a floor where patients are recovering from heart surgery. She doesn’t have on a name tag that could give away who she is, so she looks like any other nurse. White coat. Blue uniform.
“When I first arrive on the unit I just sort of do a walk-through,” she says, strolling down a hallway of patient rooms. “I take a look around to see who’s doing what and where.”
She stops once in a while to watch what’s going on inside.
“Here we have a nurse who just came, deposited some soiled linens into the hamper, and backed up immediately,” she says. “Used the Cal Stat before he goes off to his next patient.”
Cal Stat is a hand sanitizer. Hospital staffers are required to use it — or soap and water– to clean their hands before and after direct contact with every patient. They also have to clean their hands after touching any object near a patient: medical equipment, keyboards, pagers. That makes for a lot of daily hand washing.
“Here we have another nurse that came out of a room, used the Cal Stat,” Tarselli continues. “She’s now going into the next room. It does become an automatic behavior.”Over and over and over again, hospital staff squirt sanitizer on their hands each time they enter and exit patient rooms. In the 10 minutes she quietly observes this unit, Tarselli doesn’t see a single violation. “Successful survey on the cardiac unit at Mass General,” she says.
Of course, being with a stranger carrying a microphone isn’t an ideal way to run an undercover operation. But even hospital staff who didn’t seem to notice Tarselli frequently clean their hands. And this same cardiac unit recently had a pizza party to celebrate three months of 100 percent compliance with hand-washing rules.
Mass General’s track record wasn’t always this good. A chart in Tarselli’s office shows that just five years ago, the hospital sometimes followed its own hand-washing rules only 30 percent of the time. That low rate was typical of many U.S. hospitals. So unannounced inspections like Tarselli’s are one way some of them make sure their staffs follow the rules.
Another way is rap music. A nurse at Mass General made a music video, called the “Cal Stat Rap,” as a cutesy way to address a serious issue. It’s been shown to hospital officials, visitors and at educational presentations. In what could be the next YouTube sensation, it features nurses rhymin’, high-fivin’ and conga-line dancin’ as they demonstrate proper hand hygiene.
“When you go and give a little handshake,” the lyrics go, “a little squirt is all it takes. Boom boom chicka chick Cal Stat.”
Across town, Tufts Medical Center also used to have poor hand-washing rates — as low as 33 percent. The hospital’s chief medical officer, David Fairchild, says the staff knows how critical clean hands are. But when things get busy, rules get broken.
“If you ask anybody in the hospital, everybody would answer, ‘Oh, yes, washing our hands — we do that, it’s important,’ ” he says. “It’s just that in the hectic day-to-day, it’s one of those things that just occasionally gets missed.”
So last year Tufts started a hand-washing campaign using campy humor. Like a take-off on the popular Budweiser commercials. But instead of “wassup,” buttons at the hospital say “washup.” Get it? Wash up. That’s hospital humor. Tufts also makes giant stickers reminding people to wash their hands and hangs them near sinks.
Tufts claims its campaign works well enough that it now has almost 100-percent compliance. It also does secret observations, just like Mass General, Brigham & Women’s Hospital, and Boston Medical Center. But when the hospitals catch violators, they rarely punish people. They just inform units of how well they’re doing.
Hospitals like Beth Israel Medical Center don’t like the undercover-surveillance approach, since people often wash their hands more than usual if they discover they’re being watched. Beth Israel instead measures the amount of hand sanitizer used to figure out if its staff is scrubbing up enough. Using that method, Beth Israel says it has a more realistic compliance rate of about 75 percent, up from 30 to 40 percent a few years ago.
Whether it’s rap songs or secret surveillance, the goal is to reduce — and ideally eliminate — the almost two million infections that patients get in hospitals each year.