Why can't we do this in hospitals?

Wouldn't it be interesting if we could get all health care workers to wash their hands when they come to work, before lunch and before they go home? We could at least be sure that they all washed their hands 3x/day! Would it work? Who knows, but a study done in Denmark by Inge Nandrup-Bus did just that in school children ages 5-15 (AJIC December 2009) and reported significant reductions in absenteeism in the intervention school versus the control school during a wintertime 3-month pilot study.

Now, I have some issues with the methods (you can't really randomize only two hospitals, for instance), but all pilot studies can be criticized. At the intervention school all pupils were required to wash their hands when they arrived, before lunch and before they left school for home. All students in the intervention also received 2 lessons in theoretical and practical hand hygiene. Each sink hand a poster above it with proper step-by-step techniques displayed and all students were tracked for 5 types of absenteeism: URI, GI infection, skin infection, other infections and non-infectious reasons.

The multivariate analysis showed that the intervention was associated with fewer absences (0.97 vs. 1.24 periods) and fewer days missed (1.95 vs. 2.65 days). Interestingly this was seen with what can only be described as poor self-reported compliance with 19%, 31% and 9% of students in the intervention school washing their hands every day before school, before lunch and before leaving, respectively. However 52 to 69% did report compliance once in a while (around 50% of the time), so their compliance does stack up well with health care worker compliance rates.

So, should we try this in hospitals? Should we "mandate" and directly observe people coming on/off units? Should we require hand hygiene before entry into the cafeteria or on-site coffee shop?