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Clean Hands
Staff find ways to comply with the hospital’s top safety priority.

blank Hand Wash
  Pediatric oncology nurse Kristin Meerdink has made hand washing the first order of business.

Hand washing is a simple, common-sense policy. But making it as automatic as fastening a seat belt is not as easy as one might think. That’s why posters, prizes, bulletin boards and slogans have all been used to get people’s attention.

“Clean hands are proven to be the No. 1 way to prevent infection in the hospital,” says Polly Ristaino, associate director of Hospital Epidemiology and Infection Control at Hopkins Hospital. “It’s the best way to keep our patients safe.”

Hand hygiene is so important that 90 percent compliance is required by the Joint Commission. In fact, hand hygiene compliance is the hospital’s top quality and safety goal for the current fiscal year.

When the hospital first got serious about hand washing—when it introduced its WIPES campaign in November 2007—compliance was at 20 percent. The campaign doubled compliance to 40 percent. But the number stalled there for nine months. 

This fall, a fresh attempt was made to focus staff’s attention on the subject. Hospital Epidemiology and Infection Control formed a task force and in collaboration with the Center for Innovation in Quality Patient Care offered in-person classes and online training to teach staff how to establish unit-based monitoring systems. Meanwhile, trained “secret shoppers” were sent out to observe hand hygiene practices on the hospital’s 50 units and bring back data that gets posted on the Web for everyone to see. Soon, units were finding their own creative ways to emphasize hand hygiene.
One of the hospital’s top performers is the pediatric oncology unit, which reached 100 percent compliance in November. The centerpiece of their campaign was posters with pictures of patients accompanied by the slogan, What have you touched before you touched me? 

Nurse manager Lisa Fratino admits that although the intervention was clever, a combination of things contribute to her unit’s success. Because they treat cancer patients, she says, “we have a closed unit and it’s different when you have multiple services coming and going.” The unit also is fairly newly renovated and easy to keep clean. “We’ve got a stable environmental services team who has been with me for six years. So it’s not just nursing doing this; it’s multidisciplinary.”

Most importantly, she points out, “we’ve seen the fruits of our labor so it keeps people energized. They feel passionate about it. The primary goal of any care provider on this unit is to keep patients free and safe from infection, because for them infection is deadly.”

Hospital leadership has put its weight behind the efforts as well. In particular, the departments of Pediatrics, Neurology, Surgery and Medicine have offered $2,500 rewards to the first unit to achieve 90 percent compliance for two months in a row and $250 each month to the most improved unit.

But even departments without monetary incentives have been supplied with materials to improve their hand hygiene scores. A toolkit walks units through the steps to take, offers a meticulous checklist and gives examples of what other units have tried. Hanan Aboumatar, education and research associate for the Center for Innovation in Quality Patient Care who was instrumental in creating the toolkit, says transparent data reporting is also a powerful incentive. “We’re combining positive reinforcement for folks who are excelling and creating an environment for people who are doing less than optimal so they can’t continue that way. We’re changing the norm for what is acceptable.”


— Mary Ellen Miller



Johns Hopkins Medicine

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