Semi-Daily Journal Archive

The Blogspot archive of the weblog of J. Bradford DeLong, Professor of Economics and Chair of the PEIS major at U.C. Berkeley, a Research Associate of the National Bureau of Economic Research, and former Deputy Assistant Secretary of the U.S. Treasury.

Wednesday, September 27, 2006

Wash Your Hands!

Dubner and Levitt:

Selling Soap - New York Times: Cedars-Sinai Medical Center, where Bender has been practicing for 37 years, is in fact an excellent hospital. But even excellent hospitals often pass along bacterial infections, thereby sickening or even killing the very people they aim to heal....

Once Semmelweis had these doctors wash their hands with an antiseptic solution, the mortality rate plummeted. But Semmelweis's mandate, as crucial and obvious as it now seems, has proved devilishly hard to enforce. A multitude of medical studies have shown that hospital personnel wash or disinfect their hands in fewer than half the instances they should. And doctors are the worst offenders, more lax than either nurses or aides.

All of this was on Bender' mind when he got home from his cruise. As a former chief of staff at Cedars-Sinai, he felt inspired to help improve his colleagues' behavior.... It may seem a mystery why doctors, of all people, practice poor hand hygiene. But as Bender huddled with the hospital's leadership, they identified a number of reasons. For starters, doctors are very busy. And a sink isn't always handy.... There also seem to be psychological reasons for noncompliance. The first is what might be called a perception deficit. In one Australian medical study, doctors self-reported their hand-washing rate at 73 percent, whereas when these same doctors were observed, their actual rate was a paltry 9 percent. The second psychological reason, according to one Cedars-Sinai doctor, is arrogance....

So the hospital needed to devise some kind of incentive scheme that would increase compliance without alienating its doctors... e-mail, faxes and posters... the physicians' parking lot.... They started a Hand Hygiene Safety Posse that roamed the wards and let it be known that this posse preferred using carrots... they'd try to "catch" a doctor who was washing up, giving him a $10 Starbucks card as reward....

When the nurse spies reported back the latest data, it was clear that the hospital's efforts were working -- but not nearly enough. Compliance had risen to about 80 percent from 65 percent.... Murthy handed each of them an agar plate %u2014 a sterile petri dish loaded with a spongy layer of agar. "I would love to culture your hand," she told them.... The resulting images, Silka says, "were disgusting and striking, with gobs of colonies of bacteria."

The administration then decided to harness the power of such a disgusting image. One photograph was made into a screen saver that haunted every computer in Cedars-Sinai. Whatever reasons the doctors may have had for not complying in the past, they vanished in the face of such vivid evidence.... Hand-hygiene compliance shot up to nearly 100 percent and, according to the hospital, it has pretty much remained there ever since...

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