Hospital’s tough hand hygiene policy ties compliance with accountability

By: March 10th, 2010 Email This Post Print This Post

It’s not uncommon to hear about hospitals reprimanding healthcare workers for failure to comply with proper hand hygiene procedures. However, it’s pretty rare to see a facility that go so far as to threaten employees with their jobs.

But Abington Memorial Hospital in Abington, PA has taken that step, according to an article on (Not quite. See update below.)

Two years ago Abington did what many facilities have done, recruiting hand hygiene spies to track compliance rates among fellow staff members. The hospital’s policy required staff members to wash their hands before entering and after leaving a patient’s room. The hand hygiene spies tracked employees, marking a “yes” if they did both, and a “no” if they only washed their hands once, or not at all.

The first survey showed compliance at 34%, but numbers gradually approved when staff members began to recognize their noncompliance, and with the help of additional reminders throughout the hospital, including computer screensavers. Abington also rolled out a program in which staff members heard a true story about a patient who ultimately died because healthcare workers neglected to wash their hands.

By September 2009 compliance had reached 88%. However, in the last few months compliance has stayed at the 80% mark, according to the article, which led the hospital implementing one final measure.

Later this month, Abington will roll out a program that will give out index cards. Those that are seen complying with hand hygiene protocol will be given index cards that make them eligible for a prize raffle. Those who are noncompliant will receive an “infraction” on their index card.

After three infractions, that employee will get a letter stating their reappointment is “conditional.” Reappointment is required every two years  for every employee at Abington.

“What’s more serious than somebody dying from a hospital-acquired infection you could prevent?” John J. Kelly, the hospital’s chief of staff, said to

Do you agree with this approach? Is threatening workers with their jobs the only way to achieve appropriate hand hygiene compliance? Let us know in the space below.

Want to let your own hand hygiene spies loose in your facility? Equip them with a hand hygiene data collection worksheet, which you can download on the Tools page.

Update: After some fact-checking, seems this approach was not as drastic as the article indicated.

In a phone interview, Collette Hendler, an infection control nurse in epidemiology at Abington Memorial Hospital clarified that healthcare workers would not be fired for not washing their hands, they would simply get a letter after three infractions, alerting them of their noncompliance. The initiative intends to provide additional accountability after compliance rates plateaued at 80%.

“There is always the chance in anything that you do in your job that disciplinary action could go further, but termination for hand hygiene was not the plan,” Hendler says.

(Judging from the comments below, however, it seems many of you aren’t opposed to the idea of pairing hand hygiene with continued employement.)


By Teri Patten on March 10th, 2010 at 8:01 am

Unfortunately, I believe this is what is has come to. I have been doing hand hygiene compliance for years and it amazes me that healthcare providers blow off such an important step in the care of their patients.

Teri Patten RN, BSN, CIC

By Andre Pells on March 10th, 2010 at 8:27 am

I too have found that what motivates or reinforces behavior for healthcare providers absolutely varies. For many, a deepened understanding of their critical role in patient safety is all it takes to modify and sustain behavior and this can be done by educating and linking hand hygiene to very specific adverse events (a particular patient’s illness or death). However, there are still other healthcare providers for which this is not enough and who need to really know what is in it for them, and ultimately it is their job. Unfortunate that this tactic is necessary, but I can see that it is.

I agree that hand hygiene compliance should be written into each job description and failure to comply with the policy should follow the same disciplinary measures as any other non-compliance issue.

By Stephanie Boyd, RN, BSN on March 10th, 2010 at 3:12 pm

Hospital employees who fail to perform hand hygiene before and after patient contact are dangerous. Money talks; speak up.

By Annalynn Thompson on March 10th, 2010 at 3:28 pm

I agree with the approach. As a patient, I was hospitalized for 79 days & was critical several times. It gave me great comfort to see all personnel at Memorial Hospital in Colo Spgs using gel on their hands as they came into & out of my room. In all that time, not one missed. Visitors, not always. The staff’s habitual practice gave me confidence that they not only cared but did their job. Unfortunately, I do not know what incentives were used for compliance.

Seems to me that hand hygiene is the tip of the iceberg. What is found to be the underlying reason HCW’s are not following protocol? It is obvious it is not a lack of education? What is the underlying issue? Time, work schedule?

While the tactics listed in the story appear to be what migh be needed, we know that prizes, harsh punishment and other tried methods just do not work in the long run.

Unfortunately, behaviour based human issues are some of the hardest things to change. Has anyone brought in a behaviour based safety company to look at the problem? I think that may be one way to go.

My question is – are they making the doctor’s and other practioner’s just as responsible for handwashing before and after leaving a patient’s room and threatening them with loss of privileges at their facility or are they just punishing the nursing and ancillary staff?
My experience is the practioners are the worst offenders and that needs to be addressed also.

I really think it would only take the termination of 1 employee and the word would get around, oh yea they will sqwak and bawk but in the long run they will know that the facility means business and they will ultimitly comply. And I agree that physicians are sometimes the worst offenders that’s why they should all be treated the same when it come to hand hygiene compliance. REMEMBER CLEAN HANDS SAVE LIVES!


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