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just a random word that clicks in nurses' heads that they didn't
wash their hands."
4. Create a healthy competition. Ms. Kilgore has found positive
reinforcement always works better than negative, so she occa-
sionally will put together a hand hygiene "competition" with the
nurses in pre-op, recovery and the OR. She'll tally and graph
compliance among the groups, and the one that performs the
best might receive something like a paid half-day off or a free
lunch.
5. Use secret surveillance. Start a mystery shopper-like pro-
gram where a randomly assigned person will observe employees
to maintain ongoing hand hygiene surveillance. Prizes of movie
passes or a gas card go to those who comply, says Ms. Kilgore.
"It's like with your kids: Bribery works."
6. Sign of the times. By every hand rub and soap dispenser, Ms.
Kilgore has posted laminated posters from the Centers for
Disease Control and Prevention or World Health Organization
(WHO) showing proper hand hygiene measures, including the
length of time needed and reminders not to forget between the
fingers (a common misstep). She also puts the WHO's "Five
Moments of Hand Hygiene" in each patient bay and sprinkles
around some lighter signs, like a play on the ubiquitous "keep
calm" motto, that still hit the point home.
7. Survey patients post-discharge. Patients might be a little
less than forthright about their care while still in the surgery cen-
ter. "They think nurses will get mad at them," says Mr. Pankey.
His facility implements a follow-up phone survey with patients
following the procedure, asking about the providers' hand
hygiene. He believes they will be a bit more honest this way.
— Mike Bederka
