You're Fired!

Those are the two words that hospital epidemiologists everywhere wish they could say to non-compliant healthcare workers. At least it's one of my dreams. According to a story in the Philadelphia Inquirer, if you're the lucky infection preventionist at Abingdon Memorial Hospital in Pennsylvania you can actually say that to clinicians that don't wash their hands on room entry and exit. After several years of trying to improve compliance with education and constantly retelling a tragic story of a patient's death from MRSA (the mother of one of the hospital's primary care physicians), they were able to improve hand hygiene compliance from 31% to a plateau of around 80%. With this improvement they report reductions in CLABSI, VAP and SSI but not UTIs.

However, they weren't satisfied. Their new plan is to give index cards to compliant staff that make them eligible for a raffle (carrot). What do non-compliant individuals get? The same cards but with a message that they have one strike against them (stick). If they get three strikes, they will receive a letter that their reappointment is conditional and they might lose their job. It will be interesting to see if compliance improves and if anyone is fired. I suspect the observers may be hesitant to give out that third strike, but I hope not. I also hope my title doesn't infringe a Donald Trump trademark.