A new year is a good time for resolutions, and in 2023, America’s health care providers should follow the example of St. Bernard Hospital and Health Care Center on Chicago's South Side.
In 2021, this independent, 174-bed facility in the Englewood neighborhood was the only hospital in the state to earn an “F” for safety on the widely watched Leapfrog Group evaluations. In 2022, the Leapfrog Group raised its grade to a “B.”
St. Bernard is a safety net for some of Chicago’s lowest-income residents, who often arrive in especially bad shape owing to a lack of regular care. Its facility is aging, and the hospital is losing $1 million a month. Yet it was able to take huge safety strides in less than two years. The Tribune chronicled this achievement on its Dec. 26 front page.
St. Bernard managed to improve in an area that has bedeviled hospitals for decades: hand-washing practices.
One of the reasons for the “F” grade was poor hand hygiene, which leads directly to patient infections, which in turn cause preventable deaths.
The key to improved performance at the hospital was a simple, automated system of reminders. After the shock of the “F,” St. Bernard installed technology to remind staff to wash or sanitize their hands when entering and exiting patient rooms and to track how often they did so. As the Tribune’s Lisa Schencker reported, staffers now wear small electronic devices, often attached to their shirts, that beep when they enter and exit rooms as reminders to wash up or spritz.
We understand that medical professionals might find those reminders annoying, but evidence suggests they work. Reportedly, the staff at St. Bernard is now about 90% compliant with hand-hygiene requirements.
If you think like we do, you might view a 90% hand-washing rate as nothing to celebrate. It indicates that every 10th patient is being treated by someone who did not clean their hands. Isn’t it reasonable to expect compliance at 100%?
Shockingly, despite decades of proof that cleaning hands can save lives, many hospitals are still lousy at it. The Centers for Disease Control and Prevention estimates that staffers treating patients wash up at less than 50% of the rate they should. Roughly half the time, patients could be getting exposed needlessly to germs that could kill them.
We’re especially frustrated because the Tribune blew the whistle about the damage done by dirty hands in hospitals more than 20 years ago.
In 2000, a Tribune investigation showed that as many as three-fourths of deadly infections were preventable because they were the result of unsanitary facilities, germ-laden instruments or, yes, unwashed hands. Strict adherence to clean-hand policies alone could have prevented the deaths of up to 20,000 patients each year, according to the CDC and other authorities at the time.
A lot has happened since 2000, including wider adoption of technology such as automated reminders, and, of course, a pandemic that put hand-washing front and center.
It is now routine to find alcohol dispensers practically everywhere, and just about everyone is sanitizing more than ever before. Hopefully, you have taken to heart the public service messages — often posted in public restrooms — about how to wash for at least 20 seconds, which is conveniently the time it takes to hum the “Happy Birthday” song twice.
Anyone working at a hospital can’t help but be aware of these recommended procedures, but some may be too busy or burned out to follow them.
The Tribune investigation put the blame for poor hygiene on a health care industry that falsely characterized hospital infections as random and inevitable byproducts of lifesaving care. At the time, hospital operators were cutting back staff levels and ramping up workloads. Cost-cutting pressure from the top corresponded with a surge in infections, and there was reason to believe that corporate operators were more focused on saving money than saving lives.
These days, it has become common for hospitals to make a show of emphasizing hand hygiene. Many large health care facilities greet everyone at the door with a spritz of sanitizer and “foam in, foam out,” has become a common refrain for staff entering and exiting treatment rooms.
Yet some research suggests that being nagged constantly can lead to defiant behavior, even among highly trained physicians who know the correct, ethical thing to do is to clean their hands for every patient. Hospitals, meantime, have hesitated to impose the serious penalties that hand-washing scofflaws deserve to avoid alienating valued employees who in many cases have endured severe stresses from the pandemic.
This is the time for resolutions, and in this instance, the commitment could hardly be simpler. Let’s all wash our hands!
