Program will secretly monitor doctors' hand-washing

Be sure to wash up, Maryland doctors and nurses. You're being watched.

State officials said Tuesday they're creating teams of staff members at hospitals around the state to secretly monitor their colleagues' hand-washing habits as part of a first-of-its-kind program. The monitors will contribute to a systemwide report on hand-washing, using $100,000 in federal stimulus money.

Lt. Gov. Anthony Brown said individuals who are lax on scrubbing up won't be penalized. Rather, the idea is to gather information about which hospital staffs need to do a better job and raise awareness about the importance of keeping hands clean while dealing with patients

"This certainly is not an effort to do a gotcha," Brown said. "We're better off with providers actually using proper hand hygiene than calling out those that don't, so a big component of this in every hospital will be that continual education and awareness."

Teams will be formed at 45 of the state's 47 hospitals to monitor their colleagues after they leave a patient. The monitors will be given time separate from their regular duties to do the research, but they won't let the doctors and nurses know when they're being watched.

The information being gathered starting in January will be compiled into statistics on hand-washing across the hospital system and allow for comparison between the facilities. The Maryland Patient Safety Center, which works with hospitals and health care providers to improve patient safety, will implement the program.

The program is the first time a state has used direct observation to compile hand-washing data on practitioners across hospitals statewide to compare practices, said Nicole Stallings, director of the Maryland Health Quality and Cost Council. No other state has used stimulus money for a hand-washing study, either, she said.

Infections caught at hospitals and other health care facilities are among the leading causes of preventable death in the United States, accounting for an estimated 1.7 million infections and 99,000 associated deaths in 2002, according to the U.S. Department of Health and Human Services. Such infections increase health care costs around the country by an estimated $30 billion each year.

"Unlike the rest of the health care puzzle, the pieces of which we continuously search for, we can fight these infections easily and without great costs," said Brown, who chairs the state's Health Quality and Cost Council.

A membership organization for health care professionals in Maryland said it supports the program, especially because it's being implemented with input from all sides of the discussion.

"If it was being mandated without discussion then that would be a different story, but that is clearly not the case here," said Gene Ransom, executive director of MedChi, the state's medical society.

Hospitals in Maryland and other states don't have good data on hand hygiene practices, and the idea behind the initiative is to create a foundation for comparison, said Carmela Coyle, president of the Maryland Hospital Association.

"Until you collect the data, you don't know how you're doing and we can't improve," Coyle said.

Coyle also said patients should demand good hygiene from doctors and nurses.

"If you don't see your caregiver using hand hygiene protocols, ask, and I would also suggest if you do see them using appropriate hand hygiene protocols, thank them," Coyle said.

Dr. Jeff Sternlicht, chairman of emergency medicine at Greater Baltimore Medical Center in Towson, said any incentive to increase awareness about the benefits of regular hand-washing is positive.

"I just think it's a relatively low-cost, high-yield method of preventing the spread of illness within health care and within communities as well," Sternlicht said.

The $100,000 in federal stimulus money will come from $1.2 million the state received through the Centers for Disease Control and Prevention to address infections caught at health care facilities.