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Even I Had to Be Reminded To Perform Hand Hygiene

By Chris Hermann

After 12 years in a dual degree program while developing the technology that has become the Clean Hands – Safe Hands system, I have finally finished medical school. Something very profound happened during my last day of rotations in the hospital…I got called out for forgetting to perform hand hygiene!

The profoundness does not come from the fact that I forgot to clean my hands (if I’m honest, even I forget all the time), but from the fact that this was the first time in a dozen years as a medical trainee that someone ever spoke up. We were on rounds in a critical care unit and a patient had a chest x-ray that needed to be evaluated emergently. We were standing in the hall waiting for the technician to finish, and then a group of us entered the room all at the same time. That’s when it happened…I got called out.

My attending physician half-jokingly pointed to the sanitizer and smiled, saying, “Remember, Chris, clean hands are safe hands!” I kind of stood there like a deer in the headlights for a second, and then went over to use the sanitizer before checking the x-ray. After leaving the room (and performing hand hygiene unprompted that time), I had a minute to reflect on what had happened.

This was a surprising moment for me, and my reaction was one of appreciation. I was busy, focused on patient care, and I simply forgot. Plain and simple. There was no reason to make an excuse, and for me, the problem was certainly not the result of a lack of awareness or education. I was busy and thinking about the patient…and I forgot.

My second reaction was, why has it taken 12 years for someone to ever speak up? I have worked in numerous hospitals where it’s a policy for both the providers and patients to speak up if they see someone forget to perform hand hygiene, but no one has ever done so in the (likely many) times I failed to perform hand hygiene during my medical training.

Two days prior, I had been speaking with the attending physician about my plans after medical school and this is when I told her about Clean Hands – Safe Hands. The unit I was working on had been a part of the CDC-funded study that we had just completed; they had used our system for over two years. We spent about an hour talking data and brainstorming plans for a potential follow-up study. So the fact that she spoke up was due to these extenuating circumstances, and it was a miracle that it ever happened.

I wish other people wouldn’t be afraid to speak up when they see a missed hand hygiene opportunity, but that’s not the answer to a problem that has plagued healthcare for over 150 years. If we’re being honest, providers and patients won’t speak up because everyone is afraid to challenge someone else – especially if they are wearing a white coat. Making hand hygiene someone else’s responsibility won’t work. I’m willing to bet you can’t find another medical student in the country that’s better educated on the topic of hand hygiene. So education won’t work. Where was the direct observer in this case? Direct observation won’t work. The sanitizer dispenser already had a big, orange sign pointing to it. Signs won’t work. This patient already had a myriad of beeps and flashes going off. More alarms certainly won’t work.

However, when I heard a person’s voice remind me, I stopped instantly and performed hand hygiene. A real-time human voice reminder is one thing that does work.

If you’d like to explore how our system typically doubles hand hygiene performance rates and reduces HAIs by up to 75-80%, here’s a brief video about how it works. Or here’s a white paper on How the New Joint Commission Hand Hygiene Standards Could Impact Your Hospital.

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