The Hand Washing Secret Police

Earlier this month, the Salt Lake Tribune in Salt Lake City, UT reported that a local hospital had enlisted secret auditors to walk the halls and observe hand washing compliance. The auditors were instructed to appear busy writing on a clipboard and not identify themselves as observers. They watched as healthcare providers performed their daily activities and noted if they washed their hands or not. Initially, hand washing compliance was about 50%; however, after the secret auditors started observing, reporting, and notifying offenders, hand washing compliance increased to about 90%.

The response from newspaper readers has been interesting. One comment that was posted said, "Physicians are historically the worst about hand washing. They always have been (since way back when it was discovered they were transmitting post-partum infections from woman to woman via their hands) and they remain so to this day. I rarely see a physician wash his or her hands, while nurses and CNAs practically destroy their skin through hand washing and hand sanitizer use. Trust me, as soon as those docs know that no one is watching, they'll lapse right back into their filthy-handed ways." Another person wrote, "I'd like to point out that family members and friends who don't know any better are also terrible about hand washing. These must be the same people who use public restrooms and don't use soap." Another person wrote about early education, "As parents, we can all start at home by teaching our children good basic personal hygiene habits."

Something as simple as hand washing is still a problem in many healthcare settings. Secret auditors appear to be a creative way to increase hand washing compliance. However, this approach does not get at the root of the problem, the root of the behavior. What needs to happen so that healthcare providers routinely and consistently wash their hands? It's embarrassing that some healthcare providers apparently need to be observed and notified in order to cleanse their hands.