Hospital-Acquired Infections

 During a recent hospital visit, a MD making his rounds performed a brief patient examination in my presence. He introduced himself to me, we shook hands, he performed his exam and shook hands with both of us before departing the room. At no time did he wash his hands. Nurses were the subjects of my previous blogs with this same title, but I had already read complaints from other staff about doctors who don't follow hand washing procedures. Since doctors give nurses and other clinicians orders that they are supposed to follow, this creates an awkward situation.

GE has produced the graphic below, with supporting details here.

GE produced this graphic in support of their Healthymagination program, which includes the Smart Patient Room. Their press release at the May 2011 first anniversary of the program reports $700 million spent on R&D thus far, so Jack Welch's hospital-acquired infection has had quite an impact. Doctors and even visitors are not allowed to exempt themselves from hospital hand washing procedures when the Smart Patient Room technology is present. There are relatively low-tech solutions which have produced a decent level of compliance, e.g., the Targeted Solutions Tool, but I favor the medical error reporting system that is part of the Smart Patient Room technology.

From the above graphic, you can see why Medicare/Medicaid is proposing that hospitals and clinicians not be reimbursed for HAIs. The savings to the programs would be significant. Also, this is part of the push for electronic medical records, with electronic entries made in a patient's records for the sake of prevention of many sources of errors, e.g., patient identification, administration of the correct drug in the correct amount and at the correct time, confirmation that all surgical tools and sponges have been removed from a patient before suturing, etc.

The figure below from Infection Control and Hospital Epidemiology 32(4):388, 2011 (pdf). is cited as an indication of what is probably happening now. Since this and other studies are retrospective based on laboratory and patient discharge data, current national numbers await definitions for HAIs and standardized laboratory testing.

The five year trend for ten hospitals in the Duke Infection Control Network indicates that the incidence of Clostridium difficile has surpassed methicillin-resistant Staphylococcus aureus because the incidence of the latter has been dropping. The efforts made for MRSA control now need to be extended to C. difficile.

Hospital-Acquired Infections

Continuing from a friend's experience that I blogged about last September 1st, now consider General Electric Healthcare's response to the hospital-acquired spinal infection of Jack Welch, retired GE Chairman and CEO. Last month their Smart Patient Room technology began observing hospital room hand-washing practices. Sensors detect and differentiate patients, visitors, hospital staff, nurses and doctors. Hospital workers who do not wash their hands before and after patient contact are entered into a Medical Errors Reporting System. GE's press release states:

"With the integration of this new technology into existing hospital rooms, the Smart Patient Room solution is designed to provide clinicians with real-time monitoring for patient risk and the ability to intervene via gentle notification. The system is designed to track protocol adherence such as proper hand hygiene compliance before and after interacting with a patient, periodic clinical rounding, and monitor for increased risk of patient fall."

Maggie Mahar addresses this new development in her blog:

"As a health care reformer, I find the whole idea of setting up cameras and sensors to monitor doctors and nurses terrible depressing.  If we have to spy on doctors and nurses in order to force them to wash their hands, we might as well throw in the towel. Such surveillance suggests that our health care system is beyond salvation. These people are not convicted felons in a prison block—they are medical professionals.  The vast majority are genuinely concerned about patients and work hard to do the right thing."

Interestingly enough, GE Healthcare also supports the non-profit Center for Transforming Health Care, whose Joint Commission developed the Targeted Solutions Tool with eight voluntarily participating hospitals, raising hand hygiene compliance from a 48% baseline to 82% sustained for eight months. A non-technological, relatively inexpensive teamwork approach is indeed possible. In another study, calculating from hand-hygiene product consumption, McGuckin, et al. found a baseline rate of 26% in intensive care units and 36% outside the ICU. Feedback to the personnel involved increased these rates to 37% and 51%, respectively, still a poor performance.

Considering a friend's experience of zero hand-washing compliance, the impact on patients' quality of life due to poor hospital hygiene, and the billions of health care dollars wasted annually due to medical error, I am in favor of GE's approach to behavior modification.

What approach do you suggest?