By CHERIE BLACK
As she walks with her mother into the front lobby of Children's Hospital and Regional Medical Center in Washington state, a 3-year-old girl reaches above her head to squeeze some hand sanitizer into her hand. The kiosk prominently placed in the middle of Giraffe entrance lobby is taller than she is, but almost instinctively, the toddler knows to slather the antibacterial sanitizer over her tiny hands.
Before MRSA -- methicillin-resistant Staphylococcus aureus -- seeped into everyday conversations and the public wondered where the antibiotic-resistant bug would strike next, Washington hospitals were looking at ways to reduce infections within their walls.
The solution: Wash your hands.
The surprise: That so few health care professionals were regularly doing so.
MRSA, which has been common in hospitals for years, more recently began spreading outside hospital settings. Still, about 85 percent of cases take place in health-related settings, according to the federal Centers for Disease Control and Prevention.
The CDC's October report estimating that more than 90,000 Americans are sickened annually by MRSA, and nearly 19,000 die from it each year, caused mild panic and questions about what can and should be done.
In 2005, the Washington Hospital Association started a program to reduce infections. The next year, a formal hand hygiene program was launched, with patient participation in mind. Patients are encouraged to ask their doctors if they've washed or sanitized their hands before an appointment. The association also measures how much soap and sanitizer a hospital uses by counting empty bottles and comparing that number to how many patients spend the night at the hospital. They then send each hospital a monthly report.
The voluntary program involves about half the hospitals statewide, said Carol Wagner, the association's vice president for patient safety. The rest of the hospitals are using observational methods to help increase hand hygiene, she said.
The Washington Hospital Association "took this on two years ago when MRSA wasn't all over the news," Wagner said, noting a 35 percent average increase in hand hygiene compliance among hospitals in just under two years.
"Hand hygiene seems like it would be easy, but it's a cultural and physical behavior. It's a compliment to physicians that patients are participating in their care."
A 2002 CDC-published "Guidelines for Hand Hygiene in Health Care Settings" said the reasons staff members gave for not washing up regularly were not enough time, a lack of soap and paper towels, sinks inconveniently located, and patient needs taking priority over hand washing. They also believed there was a low risk of catching an infection from a patient.
Enter alcohol-based sanitizers. The guidelines showed that not only did sanitizers do a better job of disinfecting hands than soap alone, they took less time to use and were more accessible than sinks. According to the guidelines, during an average eight-hour shift, a nurse spends 56 minutes washing his or her hands with soap and water. A hand sanitizer consumed 18 minutes of the shift.
At Children's, an observer in 2001 collected data that showed about a 60 percent compliance for hand washing, said Dr. Danielle Zerr, medical director of infection control.
That "wasn't a huge surprise it's 40 to 60 percent in studies nationwide, but we wanted to attack this vigorously and get our rates up," Zerr said. "It's challenging for busy health care workers to spend the time required to frequently wash hands with soap and water. Alcohol hand sanitizers take much less time and have helped us improve hand hygiene."
Gels -- and spies -- can be credited for increased compliance at Children's, which now is up to 88 percent. The hospital has been anonymously observing and recording staff hand hygiene in all units for the past six years after realizing they should be keeping track of compliance, Zerr said.
Children's Hospital has hand gel dispensers inside and outside each room.
There's also a competition between nurses, physicians and other staff members to see who does the best with hand hygiene. Children's added hand gel dispensers to the outside and inside of all patient rooms.
"This year, hand hygiene is a hospital safety goal and we're looking more into holding people accountable for their practice," Zerr said.
"Increased awareness and concern about infections is what's driving this program. Certainly there are situations where the vast majority of the time we can reach 100 percent (compliance)"
Evergreen Medical Center in Kirkland is at or above 90 percent compliance, according to the monthly hand washing reports the hospital receives from the state.
A Washington State Hospital Association brochure is also placed in the handbook given to patients and their families. Physicians and staff also wash their hands in front of patients in rooms or treatment areas whenever possible.
Virginia Mason Medical Center launched a "wash your paws" campaign with employees last month. Buttons in University of Washington and Washington State University colors were passed out to employees which say, "Ask if I washed my paws." The idea is to encourage patients, guests and employees to constantly be aware of hand hygiene. The hospital will begin tracking compliance in 2008 in hospital departments and clinics.
Since September of last year, a hand hygiene committee has met monthly at the University of Washington Medical Center to see what can be improved. The hospital also is involved in the state's initiative and scored 85 percent compliance for the month of October, said Estella Whimbey, the hospital's associate medical director.
"The fundamentals of infection control are hand and respiratory hygiene," Whimbey said.
"It's the most important factor in reducing infections and is our No. 1 priority. Once we do that, everything else falls into place."
By CHERIE BLACK