Extreme infection prevention

The new "didn't wash hands!"

There are differences of opinion on how to motivate healthcare workers to comply with infection prevention measures. Some hospitals favor carrots. Others prefer sticks. And then there's the University of Pittsburgh Medical Center's Rambo approach. As reported in the Pittsburgh Post-Gazette, the hospital has implemented a new policy to improve handwashing compliance. Attending physicians who fail to wash their hands are fined $1000, residents and fellows $250, and all others will be sent home. It makes the old Far Side cartoon with an alarm and sign (didn't wash hands!) seem quaint.

This approach worries me. It's punitive and adversarial, and in the end, may damage the trusting relationship between hospital epidemiology and healthcare workers that I think is needed for effective infection control. Other hospitals have had successes in improving hand hygiene compliance without resorting to such extreme measures. It's really quite rare for a healthcare worker to refuse to wash when confonted, and offenders can still be held accountable. It makes me wonder how bad hand hygiene compliance must have been to drive this approach.

Well, I sure hope this strategy works, since I shudder to think what could be next. Public stocks? Caning? Finger amputations?

Oh, one last question:  who gets the money?