By Peggy McDaniel, BSN, RN
It has finally gotten serious. Patient care workers at Abington (PA) Memorial Hospital can be fired for not washing their hands.
It’s as simple as that. After two years of promoting hand hygiene through education and feedback to staff, the “gloves have come off.” Sorry for the pun, but I find this article very timely considering that it is Patient Safety Awareness Week. What does hand hygiene have to do with patient safety? Quite a bit, it turns out. Abington Memorial has a personal story to tell their staff. It is about a patient, Catherine Zakrzewski, who died from an infection acquired while at their hospital. Before she died, this patient gave permission to the infection control staff to use her story for their campaign. Her story lives on and is hard to ignore. Her son happens to be a doctor at the hospital, and as a patient safety committee member he allows the hospital to continue to use his mom’s story as an example. Putting a face to the issue has made a difference.
She sailed through surgery, rehab, and went home,” said Kevin Zakrzewski, her son, a primary-care physician who practices at Abington.
But at home, a kneecap split, which happens from time to time, requiring more surgery.
Back in the hospital, Pat Zakrzewski acquired an infection, one of the worst kinds, MRSA, resistant to antibiotics.
What followed was a nightmare: removal of her new knee, amputation of a leg, and, ultimately, after a combination of 20 surgeries and hospitalizations, her death . . . .
Abington Memorial has spent the last two years focusing on hand hygiene. They employ “spies” who monitor compliance and provide instant feedback, both positive and negative. This is not a new idea—it is being done across the country to promote compliance to hand hygiene policies. So far, this is the first hospital that may actually dismiss staff for poor compliance. In light of the fact that most states now must report their infection rates, and reimbursement for infections acquired in a hospital have been cut, this drastic yet necessary step may soon be coming to a facility near you.
As clinicians we have been encouraged over and over to wash our hands. Most hospitals now have campaigns to promote hand hygiene, but actual compliance remains low. Why do we find it so hard to take the few seconds needed to do this? Yes, I’m a nurse too. I realize how busy we are and that time is at a premium. I didn’t used to be 100% compliant, I fully admit it, but I am now. I am driven by the knowledge of stories such as the patient from Abington Memorial.
Most hospitals have gone to great lengths to place waterless hand hygiene dispensers almost anywhere they are needed. Lack of time is becoming a less tolerable excuse. Maybe you have a skin allergy or problem with the sanitizer? Work with your infection control staff to make changes, or carry a product in your pocket that you can tolerate. What excuses have you or your collegues used, and how can we move past them?
I believe none of us go in to work and think to ourselves, “I’m not going to wash my hands today.” We don’t plan to harm patients, but our inaction may very well do so.
The next time you run out of a room on the way to your next task, picture your mother in the next bed—and take the time to wash your hands.
Myself, I do not understand what is so hard about washing one’s hands or using the hand sanitizers on the walls & in patients room. It takes 5 seconds to push the level on a hand sanitizer and rub ones hands together. And washing the hands? It’s habit forming. A case in point. I use to work for USPS & keyed on letter sorting machine keyboards. We had 12 people in a rotation & we would key 10 minutes at a time & then go sweep the mail from the machines into the tray carts. I would see people eat finger foods, sneeze into their hands, pick their noses, pick at their teeth, you name it people do it. So anyway, when one person on our crew would get sick, wa la, everyone would get sick, because no one washed their hands after doing the above mentioned things. The germs on the keyboards got passed around. However, I did not get sick because I was constantly washing my hands & not touching my face nor was I eating & then sitting down to key. As I said, handwashing it’s habit forming.
Editor’s note: Barbara, thanks for clarifying this point. The sentence in question will be amended to more clearly indicate that firing for noncompliance remains only a potentiality at your hospital. We see how it could be taken to suggest otherwise as it now reads. -Jacob Molyneux, blog editor
Dear Ms. McDaniel,
In your article which refers to my hospital’s handwashing initiative, you say, “So far this is the first hospital that is dismissing staff for poor handwashing compliance.” Please note that Abington Memorial Hospital has not fired a single staff member for not washing his or her hands.
As a learning organization, we encourage our employees to learn from and correct their mistakes. If we, as nurses and care providers, truly put patients first and foremost, we should always be washing our hands prior to entering a patient’s room and after leaving. If an Abington employee is a repeat offender in this process, there are a number of opportunities for improvement that would occur prior to termination. We hope that we would never have to resort to such drastic measures. However, it would be irresponsible for any of us to compromise patient care with chronic non-compliant staff at the bedside.
Our improvement efforts raising our hand hygiene scores to 88% from 30 have been acheived with education, encouragement, incentive, unit based campaigns and recognition over the past 2 years. Sustainability is the hardest part of our work and holding staff accountable in a supportive environment is essential to our excellence.
Barbara Wadsworth
Senior Vice President, Patient Services/Chief Nursing Officer