It’s often easy to catch a colleague not doing something they ought to, such as reloading an empty printer tray, holding an elevator or thoroughly washing their hands. But what about commending co-workers when they do execute these tasks?

This was one tactic that a few patient care units at The Johns Hopkins Hospi­tal recently used while trying to boost their hand hygiene compliance rate. Proper hand hygiene, which includes washing with soap and warm water or using an alcohol-based hand rub such as Purell, is one of the easiest and most effective methods of infection preven­tion. Team members were excited to be “caught” practicing good hand hygiene as part of a six-month competition between endoscopy and the Weinberg, Zayed 3 and pediatric postanesthesia care units.

The Department of Hospital Epide­miology and Infection Control (HEIC) recognized that these four patient care areas were consistently struggling to achieve the hospital’s compliance goal, which is 90 percent or greater both overall and within individual units. Hospitalwide, hand hygiene compliance is monitored by “secret shoppers” who randomly observe providers and record whether they perform hand hygiene when they enter or exit a patient’s area of care. HEIC challenged the staff members to compete for significant improvement to their hand hygiene compliance rates over a six-month pe­riod ending in October.

At the end of the competition, endos­copy came out on top with an overall compliance rate of 93 percent, a more than 30 percent increase over its compli­ance score of 64 percent in April 2017. “We were motivated by a competition and when we were doing well, it really helped,” says Kira Rashba, endoscopy nurse clinician.

During the competition, the endosco­py team invited HEIC to perform two demonstrations for staff members so that they could clearly see the impact of poor hand hygiene. They observed the stark difference between three-day-old germs in a petri dish left by clean hands versus unwashed hands, and they used a black light to trace the path of glowderm powder left on high-touch areas throughout a typical workday. “Mostly it hadn’t spread to other places, but we could see where wiping with disinfectant wipes was insufficient to get rid of the ‘germs,’” says Rashba.

Also, the pediatric PACU team looked to “catch” providers who per­formed hand hygiene and reward them with “candygram” messages—sweets accompanied by a positive note. Mem­bers of the Zayed 3 PACU team audited each other on hand hygiene compliance for a chance to win monthly gift cards.

Several teams identified a com­mon challenge of what exactly defines a patient’s environment. “As a PACU, most of our patients are in bays as opposed to rooms,” says Lisa Slattery, nurse clinician in the pediatric PACU. “I think the culture in the hospital has ingrained in people that as they enter a ‘room’—through a door—they need to ‘gel in and gel out.’”

Reminding team members that hand hygiene should be performed regard­less of how the boundaries of a patient’s environment appear was a contribut­ing factor in improving hand hygiene compliance. “The curtain is the door,” agreed Rebecca Griffiths, nurse clini­cian in the Zayed 3 PACU.

At the end of the competition, all four teams were confident that they could keep up with their compliance success. In addition to endoscopy’s 93 percent compliance rate, the pediatric PACU finished overall at 92 percent, the Wein­berg PACU at 91 percent and the Zayed 3 PACU at 88 percent. With all four teams at less than 75 percent compliance in April of last year, the competition was considered a huge success in im­proving hand hygiene compliance and, in turn, improving patient safety.