More freaky feedback, please

In a post today on his “Freakonomics” NY Times blog, Stephen Dubner continues the hand hygiene discussion Mike blogged about recently. He highlights a reader comment about “closing the loop” by providing real time reminders to doctors that their hands are contaminated. I agree that providing frequent and timely reminders is a critical part of improving hand hygiene, but I don’t think it is necessary that such reminders focus solely on the presence of microbes….I (unlike some of my colleagues) believe that most physicians have accepted the germ theory of disease, and most also realize that their hands can (and do) carry pathogens that pose risks to patients.

So I think several varieties of feedback will do: adherence rates, infection rates, bedside reminders from patients, families or healthcare workers, the intermittent presence of a discreet observer, any of these will help. It is essential, though, that such feedback be provided as close to the point of care as possible (we all know how effective feedback is when given in a large auditorium or conference room!). And as for the common refrain that we’ll never achieve sustained adherence rates over 60-70%? Wrong. We have plenty of experience now that higher rates can be both achieved and sustained.