By Peter Laird, MD
I read an article linked on Gary Peterson's RenalWeb today that made me wonder what kind of a brave new world we are entering. The article from New York Times describes how a hospital implemented a combination of video surveillance and immediate feedback to improve dismal hand washing practices:
During the 16 weeks after the installation of the signs, compliance rates jumped to 81.6 percent, and for the next 18 months the average rate was 87.9 percent.
“People’s behavior does change when they’re being watched,” said the lead author, Dr. Bruce F. Farber, chief of infectious disease at North Shore University Hospital. “This changed the culture. It’s now three years later, and people are washing their hands at dramatically higher rates.”
The interesting data including in the study is a complete failure of video surveillance by itself. With no feedback, the rate of hand washing immediately entering or leaving a patients room was only 6.5%. It was only when the study added immediate feedback with an electronic board and reports to supervisors that hand hygiene rates improved.
Many may look at this as a promising method, but for myself, after diligently hand washing after each every patient encounter during my entire career, I find this an incredible intrusion and loss of privacy. What has happened to professionalism in health care that the workers have to have continuous supervision by a big brother video system combined B.F Skinner behavioral modification. The question we should be asking is if this most basic professional tactic to combat nosocomial infections is so utterly ignored by by nearly 95% of health care workers in the study in question, what is going on behind the scenes during sensitive procedures?
I seriously doubt that the answer to this issue will be a technological big brother Skinner approach, instead, we need to return to the basic professional integrity that the patients of America already expect. There is far more at risk than simple handwashing, the entire trust implicit in the doctor-patient, nurse-patient relationships must be questioned if today we can't even trust these respected healthcare professionals to wash their hands. What else are the healthcare professionals ignoring as well?