Cedars Sinai in Los Angeles: novel approach to increase handwashing

As reported in the Sept 27, 2005 Daily Briefing from the Advisory Council"

"Cedars-Sinai (Calif.): Takes novel approach to promoting hand hygiene
09/27/2006
Having exhausted traditional avenues for achieving widespread compliance with hand hygiene guidelines, Los Angeles-based Cedars-Sinai Medical Center adopted an unconventional approach to raising physician awareness and effecting behavioral change, according to a column in the New York Times Magazine. The hospital’s former chief of staff launched a widespread hand hygiene compliance effort after returning from a cruise, during which he noticed that crewmembers—who dispensed hand sanitizer during the re-boarding process and in the buffet line—were more vigilant than hospital-based providers about proper hand hygiene. Initially, Cedars-Sinai “gently cajole[d] the doctors” with faxes, e-mails, and posters advertising hand hygiene guidelines. Recognizing the need for more proactive intervention, the facility enlisted nurses to police physicians’ compliance, distributed bottles of hand sanitizer in the physician parking lot, and deployed a “Hand Hygiene Safety Posse” to award $10 Starbucks gift cards to physicians who were “caught” washing their hands. Administrators note that although these efforts raised compliance from 65% to 80%, the facility still fell short of the JCAHO-mandated 90% threshold. To take the facility’s performance to the next level, a hospital epidemiologist cultured the hands of providers involved in the hand hygiene effort and created a screensaver to be displayed on every hospital computer featuring images of the “disgusting and striking” bacteria revealed by the cultures. According to administrators, the screensavers helped push compliance to nearly 100%, a level that the facility has sustained ever since (Dubner/Levitt, 9/24). "