Monday, August 27, 2012

Hospital installs hand washing surveillance cameras

Doctors and nurses in the ICU at Long Island’s North Shore University Hospital are being watched by 39 video cameras in an effort to increase compliance with hand washing. According to a report hand washing compliance is up from less than 10% to 90% since the program started.

Cameras are positioned near the doors of patient rooms and at sinks Patients are not being videoed. The real-time feed is observed by workers in India. Staff failure to wash hands is noted, and the results are posted on electronic bulletin boards in the unit. So far, miscreants are simply talked to.

"No one's been fired, no one’s been written up but there have been one-on-ones," the news story says and, “Infections have decreased though an exact percentage was unavailable.” That raises the question of how they would know if infections have really decreased if the exact percentage is unavailable. And there’s another question, “Is the decrease statistically significant?”

This venture, while well-intended, seems like a bad idea to me. I suppose you are thinking, “Could Skeptical Scalpel really be against hand washing?” Well, I’m not. But what seems logical and correct sometimes may not be. For example, everyone knows that sinks with faucets that have electronic eye sensors are cleaner and better to use in hospitals than sinks with manual faucets, right?

A study presented at a meeting of the Society for Healthcare Epidemiology of America last year by a group from Johns Hopkins concluded the following: Electronic faucets were more likely to become contaminated with Legionella spp. (species) and other bacteria after water system disruption. Electronic faucets were less likely to be disinfected after chlorine dioxide remediation. Electronic faucet components may provide points of concentrated bacterial growth. These findings led to removal of all electronic faucets from clinical areas in our institution. [Emphasis added.]

Washing hands with soap and water may cause dryness and irritation resulting in skin breakdown. It may be that constant, obsessive hand washing and use of gels could promote the emergence of resistant organisms.

Another potential issue with the video observation is a false accusation of failure to wash. Patient rooms and patients themselves are not being watched. Let’s say a nurse went into a patient’s room to tell him something and didn’t touch anything. A person in India watching a video from a camera focused on a door or sink would not be able to tell that. If the nurse doesn’t wash her hands when she leaves the room, is she going to be cross-examined?

And what about cost? How much does it cost to install and maintain 39 video cameras, stream the video to India and pay people there to watch the monitors and feed back the information 24 hours per day? Remember, they have no proof that video surveillance reduces infections.

What does this scheme say about the relationship of the professional staff to the hospital’s administration? More problematic is the fact that even though they know they should, doctors and nurses at a major medical center apparently cannot be trusted to wash their hands unless they are spied upon. What else do they not do?

Instead of issuing press releases about this ill-advised program, hospital management might want to consider investigating why their staff is non-compliant.


WakingUpCosts said...

Our hospital is encouraging patients to report 'doctors' who don't wash their hands. Not other hospital staff. Just doctors. Nice.

Skeptical Scalpel said...

Nice, indeed. Great place to work.

huhet said...

I obviously don't have any practical experience, but 10% compliance seems pretty low to me. Are they supposed to have 100% compliance? I don't know the rules/norms of hospital life.

Carolyn Thomas said...

Instead of focusing on the intrusive cameras, I'm curious about why you are not positively horrified at the stats that only 10% of ICU staff were washing their hands before these cameras were installed?

10%? TEN PER CENT?!? That is the truly disgusting part of this story.

As a patient who's been in the ICU, I (and virtually every other patient I know) can tell you horror stories of watching staff move from one patient to the next while performing procedures that really do call for handwashing before and after. In fact, are you aware that one of the more anxiety-producing dilemmas discussed by patients online is: 'how do I politely ask my doctor/nurse/tech to wash his/her hands before touching my dressing/wound/body?'

Bring on more of those cameras....

Anonymous said...

Transmission of bacteria from patient to patient to patient by healthcare professionals causes harm and in some cases the death of hospital patients. Wash your hands already! What healthcare professional in the year 2012 does not know that infections and deaths are reduced by hand washing? Just can’t comprehend that bacteria are so small as to be microscopic?

The 2 of the 3 “p values” in the electronic sink study are greater than 0.05. That plus common sense behooves me to ask why manual sinks are preferable? Seriously. Antibiotic gels or soaps can cause bacterial resistance, not frequent hand washing with soap and water.

Please review physician John Snow/cholera/1854. It took him a while to get his point across too.

Skeptical Scalpel said...

Thanks for the three comments. Yes, compliance should be 100%. As I said in the post I am not against hand washing. I am in favor of finding out why the docs there did not wash their hands.

Antibacterial soap and water can dry out the skin of the hands. Irritated skin can become infected.

I don't know what type of work you do, but would you like to be under video surveillance all day? I would not. As I said, it shows a lack of trust. It would be better to solve this issue by getting at the reasons why doctors don't wash their hands.

Unknown said...

Sorry, doc, but I'm with Carolyn Thomas. A 10% compliance rate would seem to have EARNED the distrust you lament. Since nothing else seems to be working, do what works. And a nine-fold increase in compliance shows it's working.

Stop complaining about what works and get the remaining 10% to do the right thing. Oh, two more things...who says it always has to be antibacterial soap? And why haven't the docs taken the leadership on this?

Carolyn Thomas said...

Trust, schmust. Health care professionals working in an ICU in which only 10% of them wash their hands have forfeited their right to be insulted, offended, or upset by installation of spy cams to make them smarten up.

That skin-irritating antibacterial soap is unnecessary - hot water and soap work. Besides, if skin irritation were indeed a valid excuse for neglecting handwashing, we would not likely see an improvement in stats from 10% to 90% compliance.

What's your best guess, by the way, about WHY such an appalling majority of intelligent, informed, educated people are not already doing what they know they should do to keep their patients safe - until they're being filmed?

Skeptical Scalpel said...

Thanks for the comments.

I have no proof, but I would guess that if the compliance rate was really 10%, the docs at this hospital are the real problem. That would be way below the average hand washing compliance rate for most hospitals I have been in. I suppose that answers the question of why they did not take the leadership role.

It's antibacterial soap because that's what most hospitals use.

Skeptical Scalpel said...

I don't know why doctors in that hospital were not washing their hands. Maybe someone should have asked them. I think that would be a very interesting research project.

Another interesting project would be to see how this surveillance is working out in 3 to 6 months.

Personally, I not only wash my hands to protect my patients, I do it to protect myself. It seems to be an issue of common sense.

Anonymous said...

That's because doctors are always the least compliant with hand hygiene

Anonymous said...

I agree with the assessment, plus the study itself is pretty uninteresting. In their own words, the starting point, pre camera's were "6.5 percent of workers on average washed their hands within 10 seconds of entering or leaving a room."

Big deal. I'll admit I rarely wash my hands within 10 seconds of entering/leaving a room. I do however wash them before touching anything in the room or after touching anything in the room (patient, objects, etc.). Heck, as a medical student sometimes I won't wash my hands at all if I am rounding with a team and know I won't be doing anything other than standing in the corner, observing and occasionally getting pimped. Why dry out my hands more than they already are for no good reason?

Of course if I am entering the room of a patient who is ill or immune suppressed I not only wash my hands but glove/mask up as well, even if there aren't isolation precautions posted. Heck I'll even rewash my hands if I end up shaking the hand of a parent, spouse or child of a patient before going back to the patient. It's just common sense, which is lost by bureaucrats making dumb rules like "everyone must wash their hands within 10 seconds of entering/leaving a patient's room."

People might argue well "everyone in the ICU is really sick!" you should always be in hypervigilant mode. Such people have never worked in an ICU. While I haven't done a rotation in an adult ICU, I spent a lot of time in the PICU. For every patient with some horrible infection, there is another there because they have DKA, status asthmatics, status epilepticus or a variety of other conditions that are neither contagious nor imunosuppressive. Again I would never touch a patient or anything in there room and not wash my hands afterwards, but why should I wash them just because I stepped over an arbitrary threshold?

Skeptical Scalpel said...

I agree with you. Your comment reflects the fact that you have common sense, a rare and desirable quality.

Dave said...

(previous anonymous poster). I finally stepped foot in the adult ICU today to drop off a patient who had a T7-L2 spinal fusion (I'm on my anesthesia rotation). It's amazing how different the procedures were between it and the PICU. Everyone on the ICU team had to don yellow "isolation" robes and gloves before entering any room (even our patient who was only there because she has some restrictive lung disease/needed to be monitored overnight). Oddly enough they didn't even have masks on the carts that had the gloves/robes. I would think that gloves/masks would prevent more disease than gloves/robes (and are less of a pain to put on).

Skeptical Scalpel said...

Dave, thanks for commenting. Putting everyone in the ICU on isolation is a new one on me. I doubt there is any evidence justifying doing that and it may be harmful. There is published evidence that patients on isolation are seen less frequently by the staff.

Anonymous said...

At Anon:

"Again I would never touch a patient or anything in there room and not wash my hands afterwards, but why should I wash them just because I stepped over an arbitrary threshold?"

That's what they all say!!!!!!! until the clipboard and pen comes out and you see that's a lie lol

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