Watching the Hospital Hand-Washing Watchers

The installation of surveillance cameras to keep an eye on doctors' handwashing habits would be a final vindication of Ignaz Semmelweis, (July 1, 1818 – August 13, 1865). This Hungarian physician came to be called the "saviour of mothers" as a result of discovering, by 1847, that the incidence of puerperal fever, also known as childbed fever, could be drastically cut by use of hand washing standards in obstetrical clinics.

In Austria in 1847, doctors sometimes dissected cadavers, then went on to deliver babies without changing their coats or washing their hands! Up to about a third of mothers who had given birth consequently died from puerperal fever, also known as childbed fever.

Semmelweis introduced hand washing with chlorinated lime solutions for interns who had performed autopsies. This immediately reduced the incidence of fatal puerperal fever from about 10 percent (range 5–30 percent) to about 1–2 percent.

Semmelweis' hypothesis, that cleanliness was essential, was largely ignored, rejected or ridiculed at the time. He was dismissed from the hospital and harassed by the medical community in Vienna, which eventually forced him to move to Budapest.

Semmelweis was outraged by the indifference of the medical profession and began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers. His contemporaries, including his wife, believed he was losing his mind and he was in 1865 committed to an asylum (mental institution). Semmelweis died there only 14 days later, possibly after being severely beaten by guards.

Semmelweis' practice only earned widespread acceptance years after his death. He is considered a pioneer of antiseptic procedures.

Watching the Hospital Handwashing Watchers

MultiCare Health System implemented a hand hygiene program in 2006, modeled after the “Partners in Your Care” program from the University of Pennsylvania. We measure all the soap and gel used each month on each unit. Using the PIYC formula, we obtain a rate for each unit. The benchmark, also from PIYC, is 72 hand hygiene episodes per occupied bed day; for ICU it is 144 and for ambulatory, 6 per patient visit. The percentage of compliance is graphed and sent to the manager of each unit to share with staff and the graph posted in the staff lounge. Our CEO personally calls each manager if they are not at 90%, asking what she can do to remove barriers and help them get to at least 90%. We have some areas that are well above 100%, meaning that they exceeded the 72, 144 or 6 hand hygiene episodes per occupied bed day. We also do visual monitoring during tracer rounds by Quality Management and Infection Prevention staff. This has confirmed our high levels of compliance. All four of our hospitals have been surveyed by Joint Commission this year, none of them received a hand hygiene finding.

For 2007 and thus far in 2008, we have a sustained level of over 90% for the organization. We credit this to having the right product in the right places, staff education and support from the top. We have seen decreases in infections across the board. We can’t attribute all of them to improved hand hygiene as we have several other initiatives in progress at the same time. The point is, hand hygiene compliance CAN be achieved without cameras, armed guards etc. It is a culture change within the organization, supported from the top, with easy access to a good product.

Marcia Patrick

Director, Infection Prevention and Control

MultiCare Health System

Tacoma, WA