Slashdot Mirror
Hospital Resorts To Cameras To Ensure Employees Wash Hands
onehitwonder writes "Long Island's North Shore University Hospital is using sensors and video cameras to make sure employees wash their hands, according to an article in today's New York Times. Motion sensors detect when hospital staff enter an intensive care unit, and the sensors trigger a video camera. Feeds from the video camera are transmitted to India, where workers there check to make sure staff are washing their hands. The NYT article notes that hospital workers wash their hands as little as 30 percent of the time that they interact with patients. The Big Brother like system is intended to reduce transmission of infections as well as the costs associated with treating them."
Ewww.
Check out my sci-fi/humor trilogy at PatriotsBooks.
One puzzle is why health care workers are so bad at it. Among the explanations studies have offered are complaints about dry skin, the pressures of an emergency environment, the tedium of hand washing and resistance to authority (doctors, who have the most authority, tend to be the most resistant, studies have found).
But... hang on a bit... how come 20 years ago this wasn't an issue?
Questions raise, answers kill. Raise questions to stay alive.
Part of the problem is that the medical education system is deliberately set up to ensure a continuous shortage of doctors. As a result, all doctors have extremely high pay and are almost immune to any kind of employee discipline; they know that the hospital needs them more than they need it. We let the AMA run medicine like a medieval guild, while almost everyone else is exposed to ruthless market competition – it's no wonder that we get nonsense like this, and that health-care costs have been rising faster than inflation for decades.
You're Cube Man #3,948 and every day, for 8 hours straight, you watch these TV feeds. It all looks the same. There is no audio. There is nothing interesting happened. Whenever you see someone wash their hands, you push a button.
Pop quiz: How long before you're bored senseless and start making mistakes... or not caring?
Psychology tells us that repetition and boredom leads to mistakes. This system is a band-aid, it does nothing to address the environmental conditions that are causing the behavior -- those are what need to be tweaked. You cannot make lasting changes to a person's behavior through threats, manipulation, guilt, and shame. Temporary, yes. But it wears off, and you're left with the situation of having to increase the level of abuse repeatedly, creating a vicious cycle that demoralizes people and makes them resentful.
Is that really the psychological state you want a guy whose job it is to cut people open and prescribe them powerful and potentially deadly medications? Come up with something better, people. This kind of social engineering has never been effective. The airline industry licked this problem a long time ago -- they're called checklists, copilots, training, and redesigning the environment and paying close attention to work loads. And the reason all of that was implimented is because the government got sick of corporations cutting corners on safety, training, and creating cultures of fear.
More people now die in hospitals than plane crashes. I think if government regulation of the industry worked to reduce the risk of flight to such a low level that it has become the safest mode of transport, that we can at least make our hospitals achieve half of that success. 30% is pretty damn pathetic, guys.
#fuckbeta #iamslashdot #dicemustdie
Doctor's may be immune to discipline but nurses are not.
Nursing schools are cranking out young, low wage nurses, for which the hospitals are looking for any reason to get rid of the higher paid and older nurses... I know a nurse, she's in her 50s, been an RN all her life and still is forced to work x-mas and Thanksgiving otherwise her hospital will replace her with the girls coming out of the local nursing school.
Reminds me of the programming industry...
I'm picturing an xbox kinect-ish system that tracks each person entering, follows their movement and the movement of their limbs, and remembers if your hands got close enough to the sink / sanitiser. Then only if you head towards ICU and attempt to open the door, an alarm sounds so that your peers in the room notice, and a video recording is kept.
09F91102 no, 455FE104 nope, F190A1E8 uh-uh, 7A5F8A09 that's not it, C87294CE no. Ah! 452F6E403CDF10714E41DFAA257D313F.
It still doesn't excuse his behavior, micro managers like this are an everyday thing across all industries and they invariably demoralize staff and hold back companies. So here he's been allowed to put cameras in the toilets and monitor staff for 'cleanliness', which inevitably means he monitors them for frequency of toilet breaks.
It's micro-managing and a well understood to be an incompetent trait.
Presumably Indian staff will be promoting this as a good thing, 'outsource your micromanagement', hence the -1 on the score, but the influence of doctors really doesn't excuse the managers incompetence:
http://en.wikipedia.org/wiki/Micromanagement
Effects
"Regardless of a micromanager's motive for his or her conduct, its potential effects include:
" Creation of ex post resentment in both "vertical" (manager-subordinate) and "horizontal" (subordinate-subordinate) relationships
"Damage to ex ante trust in both vertical and horizontal relationships
"Interference with existing teamwork and inhibition of future teamwork in both vertical relationships (e.g., via malicious compliance) and horizontal relationships "(e.g., exploitation of moral hazard created by poorly proportioned effort-reward structures)."
Note the terms like 'malicious compliance', where such incompetence pisses people off so much they do out of there way to do the opposite. This is a common effect of such incompetent leadership.
The country is well known to have a hygiene problem. Public defecation is rampant and hot topic in the international press. Couldn't they at least out sourced to a country that is at least clean, if not cleaner than us like the Japanese or one of the Scandinavian countries?
The NYT article notes that hospital workers wash their hands as little as 30 percent of the time that they interact with patients.
Actually the hospital workers wash their hands as little as 30 percent of the time that they interact with patients if not encouraged to wash hands.
The other issue is that every interaction with a patient does not necessitate washing of hands. For example, walking into a treatment room and stating "the doctor will be in in a minute" does not require washing of hands.
I can't stand the pillar the medical profession puts itself on. Let's run down the list of examples for how the medical profession doesn't give a shit about patients, shall we?
Please help metamoderate.
So they don't trust their hospital staff to wash their hands, but they do trust Indian staff to report them.
As the article says - it is mostly about cognitive load. People focus on the hard things and forget the easy things. Checklists deal with exactly the same phenomena and have produced great results in healthcare as well as exactly the same bogus complaints about lack of trust.
The article points out that something like 100,000 deaths per year are due to infections acquired while the patient was in the hospital and dirty hands are the primary means of transmitting those infections between patients. This is a problem that absolutely must be fixed. simple "trust" has not been sufficient so far.
The indians who do the watching do not have any harder problems to distract them. They may grow bored, like anyone who has to watch the same thing over and over again, but that's manageable. Maybe they give the indians a bounty to encourage them to focus, maybe they just rotate them through other tasks frequently enough that boredom does not overwhelm them.
When information is power, privacy is freedom.
This is not special to America, in France where I live, medical studies are being severely subject to quota, the result is that the country must now import doctors from other parts of the world, especially Africa, the Middle east and Eastern Europe, when there's lots of unemployment in other fields, and while the country has perfectly all the abilities to train its own doctors. In the same time, those parts of the world are badly missing those migrating doctors.
Alcohol is bad for the skin, while soap has proven to be just as effective at germ removal. So I'm fine with this monitoring if one of the options is to use regular soap. Otherwise they might as well add an injection station where you have to stab yourself with the medical elixir du jour before leaving the restroom.
I come here for the love
Wow, these guys are employing chaps across the world to do the job, when we built our autonomous android-based solution at a hackathon last year? Only sad fact, the community for whom we built the concept (schools here in Uganda mostly), never understood the idea... or we were not entrepreneurial enough to push it beyond the initial hacks.
http://www.youtube.com/watch?v=Mg4t3u8psQU&feature=share&list=PL9nqA7nxEPgsuV4Rfs0B-oN_O2pk_ddm4
(this was in 2012, at the Sanitation Hackathon, Kampala, Uganda).
Doctor's may be immune to discipline but nurses are not.
Nursing schools are cranking out young, low wage nurses, for which the hospitals are looking for any reason to get rid of the higher paid and older nurses... I know a nurse, she's in her 50s, been an RN all her life and still is forced to work x-mas and Thanksgiving otherwise her hospital will replace her with the girls coming out of the local nursing school.
Reminds me of the programming industry...
Are you saying that if you get sick on Thanksgiving it would be best, medically speaking, to only have inexperienced nurses treating you? As a patient, you would feel okay knowing that the experienced nurses were home with their families, while you were being treated by newbies?
Battlemaster--Game with friends in medival realms
Many, many studies have shown that this type of method is less effective than proper training and motivation.
Would be better to find out why the people are not washing their hands, and fix that problem.
Lack of knowledge, facilities?
Here's an article about a better way to do it; looking at the entire system and finding ways to make getting good hygiene simple and faster.
(OK, it's from a hand-dryer company, but still illustrative of the approach.)
http://www.exceldryer.com/presskit/CaseStudy-NMH.php
People didn't get sick or hurt on weekends 50 years ago? She knew working holidays and weekends wa part of the job when she went into the field.
Time is what keeps everything from happening all at once.
they don't trust their hospital staff
When it comes to health, someone needs more than trust.
Slashdot, fix the reply notifications... You won't get away with it...
If a general practitioner saw only 2 patients an hour they would only wash their hands ~18 times during an 8 hour shift. If they see 5 patients an hour that jumps to 40 times. Forget tedium, this sounds to be a dermatology problem.
Easy fix:switch to UV LEDs. A tanning bed for your hands and copper door nobs will go a longer distance than scrubbing your fingers to the bone in order to comply with a policy.
i like this article and i fully agree with them
Is there a doctor in the house?
The down side to your model is that private hospitals have an incentive to increase the price to you as much as possible. If their operating model is to increase revenue to shareholders then there will be a drive to find financial profit where ever possible.
Something is very wrong somewhere
First, in UK hospitals, the following happened ...
http://www.disclose.tv/forum/uk-allows-muslim-nurses-to-not-wash-to-protect-their-modest-t87289.html
Now, in US hospitals, they have to snoop on their staffs, and then send the video feed to India, where they got many pairs of cheap eyeballs to spot those who have failed to wash their hands
What has actually happened to common sense ?
Muchas Gracias, Señor Edward Snowden !
India is soon emerging as the "global brain", catering to the rest of the world. It can deliver complex image/video processing tasks like checking if somebody is washing their hands. India can do natural language processing by understanding queries and responding to them. India is like a remote server serving up AI over the network at unheard of prices. Else where in India - scores of "engineers" are lined up for job interviews to show off their prowess at identifying if a person is wiping it properly or not.
Yes, of course. Being a nurse myself for the last 20 years I know of rotating holidays. They are a pain in the ass.
Time is what keeps everything from happening all at once.
And by the way, people get hurt or sick everyday, whether it is a holiday or not.
Time is what keeps everything from happening all at once.
Could you please crawl back into your sanctimonious moralising box and take a copy of "The Checklist Manifesto" with you. When you've understood a bit of the theory of safety management, you could crawl back out and apologise to the families of the many thousands of patients who have died or been seriously hurt as a result of HCAIs.
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/EpidemiologicalDataHCAI/hcaimandatorysurveillanceresults/
Look at the number of doctors per capita in each country and see how bad it is here (in the US).
Wow, sent an e-mail as suggested when clicking on "use classic" banner, and got a fast response that addressed my msg
Give each a pass card that's charged at a wash station, the charge is only good for 30 minutes or so. Don't let them do stuff without a charged card. Put an led on it to show its charge level.
Or it can be passive with an RFID that gets logged when they wash their hands, then hold them accountable.
A fool throws a stone into a well and a thousand sages can not remove it.
every successfull fast food/retail chain uses micromanaging horse-shit.
its about time doctors had to be as consistent and quality-oriented as the fry cooks at mcdonalds, especially when a major cause of death is medical errors.
But... hang on a bit... how come 20 years ago this wasn't an issue?
It WAS an issue 20 years ago. This has been a huge issue for a long time. It also turns out to be a shockingly difficult problem to solve. I've actually worked in an infection control department (about 10 years ago) at a hospital and seen first hand the difficulty they had in getting people to take basic hygiene measures to control hospital transmitted infections. Part of the problem is economic, part is attention, part is habits, part is social, part is work process design. Kind of like spam there seems to be no simple and universally effective solution to the problem.
20 years ago hospitals could hand out antibiotics like candy to deal with bacterial infections.
You seem to be implying that just prescribing antibiotics solved the problem 20 years ago. Not true. This was every bit as big a problem 20 years ago. The only difference was that we didn't pay as much attention to the problem back then. Sure there are some new complications relating to antibiotic resistance now but that was part of the equation back then too. The problem is one of prevention, not treatment. No amount of antibiotics can solve the problem and even if they could, prevention is MUCH cheaper and more effective.
We let the AMA run medicine like a medieval guild, while almost everyone else is exposed to ruthless market competition ...
Therefore we should expose doctors to "ruthless market competition"? No. We should be tempering labor laws and industry regulation to ensure high quality staff, not pretending that the market is a cure-all.
Ironically, conservatives in the US argue against "socialist" medicine, while holding up the US medical system as the best in the world. Can't be both a "medieval guild" and an exemplar of capitalism. I'd say its closer to a guild and that's part of why it works so well.
tomorrow who's gonna fuss
However, once you where finished washing, you had to pull open the bathroom door by a fairly greasy/grimy handle.... Made me glad to be able to knee the door open when entering, just before I was about to handle my privates.
I typically use a paper towel to open the door and then throw it in the nearest trash receptacle afterwards. If the company doesn't provide them you can of course keep some napkins in your desk for the purpose. A tad OCD I'll admit but I know a lot of doctors who recommend the practice. Of course a better solution is to design entrances and exits that don't require touching a door like you see in modern airports these days. The less I have to touch in a public space the better.
I always found it rather strange that bacterial infections could spread so easily in a "sanitary" environment like a hospital. Bacteria can spread through the air, i.e. by someone sneezing and someone else inhaling it, but contact (touching surfaces containing the bacteria) is the most common method of transmission.
When the hospital staph only wash their hands 30% of the time when they interact with patients, it's no wonder that this crap can spread so easily.
It's ridiculous that something which should be a matter of habit has to be enforced with security cameras.
Feeds from the video camera are transmitted to India, where workers there check to make sure staff are washing their hands.
Offshoring of hand sanitation with soap monitoring... The new little "bubble".
Wow, these guys are employing chaps across the world to do the job...
They handle(d) tech support so well that we're giving them grants to monitor safety! This isn't about $$, I assure you!
This solution is absolutely retarded. All you need to detect washing of hands is a cheap inertial reference sensor on a little tag worn on the upper body. A three-axis accelerometer and a three-axis angular velocity sensor is it. The change in posture and the sways propagating to the upper body are quite a distinctive signature, especially when you couple it with the signature of walking to the sink, and all the other things that are known to happen when you use a particular sink. You could probably tell which sink you're at. You don't need anyone in India to detect it. Modern signal processing deals with it just fine. Due to low sampling rates involved (100Hz is enough), you can do real time signal processing on a relatively low-power CPU, so that the battery life can be excellent. The system needs to check-in periodically via some RF technology, possibly simply Wi-Fi that's off most of the time, but comes up only to report significant events.
A successful API design takes a mixture of software design and pedagogy.
That's life. Deal with it.
There's an attitude that leads to malpractice. My wife is a nurse, so I'm sympathetic about the pain of working holidays. However, the GP is right. On holidays you don't have elective surgery or regular appointments, but there's still the ER and patients in wards. There's no excuse for substandard care - ever. I'm sure my wife would agree as sloppy medical care infuriates her.
Not that such issues keep hospitals from constantly increasing the patient/nurse ratios. Why pay nurses to do silly things like care for patients when you can pay administrators 2x as much to work M-F and tell the nurses that there isn't enough money.
It is by no means "a major cause of death".
So tens of thousands of deaths each year (source CDC) is not a major cause of death? What do you consider a major cause of death? And hundreds of thousands of non-lethal infections. Even ignoring the pain and suffering component the financial cost is enormous.
Unless you are working on a surgical field where near absolute sterility is required, using the hand sanitizer after every patient contact and washing your hands after a few rounds of the hand sanitizer works as well as OCD hand washing.
The effectiveness of alcohol based hand sanitizers is debatable and they are known to be less effective than hand washing.
Then there are a number of other vectors for microbial transmission that this 1984-esque system doesn't address - stethoscopes and other instruments, pens, ties, lab coats.
All true but hand transmission is the biggest among them and we know that hand washing is an effective mitigation technique.
Does this mean that they put the sinks outside the bathrooms?
Paul: Father... father, the sleeper has awakened! - Dune
That has got to be the stupidest solution to the problem that anyone could imagine. Was this the result of some drunken contest?
As a survivor of childhood cancer, my wife has been in many, many hospitals. Most are very good with basic hand washing. Most have sanitizer dispensers near the door to the room, inside the room and in the hall. But one hospital in particular stands out in my memory as having employees that seldom washed their hands. It appeared to be a hospital-wide problem as they did not have sanitizer dispensers readily available. The employees seemed surprised and "hurt" when asked to wash their hands before touching the patient.
I'm pretty sure all it really takes is a directive from the higher-ups and a little bit of education. But hey, those kids in Bangalore have to do something I guess.
"The ferrets, they're every where I tell you!"
take a copy of "The Checklist Manifesto" with you
I haven't read Gawande's book (looks interesting though) but the basic idea of checklists for safety goes at least as far back as the crash of the army test flight of the Boeing 299 (later dubbed the B-17) in the 1930's. They work, and they can and should be applied to medicine. From the blurb I looked at, it seems that in medicine he's mostly talking about surgery (he is a surgeon). That's far from the only place that nosocomial (hospital acquired) infections get transmitted.
I don't know about the UK (you referenced a UK link) or even the OR, but can tell you that a major problem in many parts of the US is the incredible time pressure on nurses for everything from med passes to dressing changes. Over the years hospitals have increased patient/staff ratios, and it shows. In some places there has been push-back resulting in legal limits on the ratio (California is one, IIRC). Here in NY and most places, no. Hospitals squeeze costs by increasing the ratio, although interestingly they had lower ratios 10 or 20 years ago when healthcare was much cheaper. The time pressure means no time for checklists or other intelligent measures. An example of those is electronic scanning and data entry of meds before giving them to a patient (med errors are a major source of problems) but administrators push back on the equipment costs and the extra 5 seconds per patient. If they cut the admin staff in half they would have loads of money for those things.
Is it 'management dickery' to have a dashboard camera to record police officers on traffic stops? Or to put a black box recorder in a commercial airliner? How about background checks for elementary school teachers? Surveillance cameras on bank tellers, or casino dealers? I'm all in favor of privacy rights for the general public, but there are certain professions that by their very nature require a higher level of scrutiny, especially on the job.
This has been a problem for decades, and less intrusive methods have not seemed to solve the problem. Yes, this comes down to a "this is why we can't have nice things" argument. But of all the things that health care professionals do that requires hard work, sacrifice, a high level of skill, or dedication to helping people, this seems like such a small additional step with a tremendous possible bang for the buck. (And please don't turn this into a slippery slope argument. You should look at the costs and benefits of any proposed intrusion on privacy on its own merits)
Bored?! Indian's won't get bored. India's avg IQ is 79.
If it's true, it shows that the real idiots are people who think that IQ scores mean much.
I always found it rather strange that bacterial infections could spread so easily in a "sanitary" environment like a hospital.
Being full of sick people, hospitals are not all that sanitary (not really a joke).
It's called seniority. Something you have to earn.
Hilariously topical malapropism.
So, it has come to this.
Have gnu, will travel.
I'm not sure if you are aware of this, but there actually are several options between the extremes of having holiday hospitals manned only by newbies and interns, and valuing workers with 20 years of experience enough to allow them perks like holidays off.
I always found it rather strange that bacterial infections could spread so easily in a "sanitary" environment like a hospital.
Also in a place where all viruses are killed, there are no bacteriophages to attack the viruses, unlike our mucous membranes.
You're right about the night shifts, weekends and holidays being a real pain for nurses (and others) who work in a hospital, but many nurses (e.g. my wife) prefer the 12 hour shifts. It's a killer work day, but having 4 days/week off is nice. That's even more true if you have kids. At least sometimes you can see them, go to school events, etc.
Next thing you know, they'll be putting cameras at every urinal to make sure you hold your dick right.
Indeed. If you only have one highly-qualified nurse on-staff, you've got a big problem in the first place. You should have several, and they can rotate which holidays they work.
This is how it works in other industries that may require on-call staff during holidays. It's a solved problem.
If you're staffed entirely with n00bs who don't know how to do their jobs... good luck with that.
Check out my world simulator thingy.
All hospitals should encourage high level contamination and infection control procedures. All staff gloved/masked, etc. You'd stop 99.999% of the transmission of infection right there.
because to the bean counters, administration is a revenue generator, as they are the ones bringing in the insurance and medicare money
Not always, but the bean counters are part of administration. Do you expect them to recommend cuts? Funny how bean counters never worry about too many bean counters being an unnecessary cost. Or is that the executives not worrying about executives being an excessive cost center? Probably both. Then there are the schmucks who waste their time taking care of patients. What a bunch of loosers.
You clearly no nothing about the AMA, nor the major factors in health care costs.
The Kruger Dunning explains most post on
Except it's not.
Older nurse have to bend over backwards to keep their jobs, so the nurses with the most seniority, who also cost the most, end up working shit jobs becasue the hospital wants them to leave.
The Kruger Dunning explains most post on
If people spent less time in hospital because nobody was spreading disease around they wouldn't need so many staff to take care of everyone.
They are staying in their country and they're smart enough to take the Americans money without even leaving their home country. All they have to do is watch TV and get paid for it. Sure its some boring hospital drama but its still a pay cheque.
It's the bathroom monitoring being done from a country where folks wipe there asses with their hands. Outsourcing is ridiculous sometimes.
-- Jimtown Kelly
Have the bathroom door handle stain the hand with a soap-soluble dye.
Sure, that won't force the staff to wash their hands as often as they should .. but at least we'll know they washed their hands when they went to the bathroom.
I beg your fucking pardon? The evidence that hand hygiene is a major transmission route for nosocomial infection is extensively documented and not just a marketing survey. I put that link up so that you could see some of the evidence for yourself. Are you going to bleat on about the survey, or are you going to look at the actual evidence about hand hygiene? You are sounding like a complete prat, arguing that there is no link between hand washing and lowered rates of HCAIs. It's on a par with arguing there's no link between smoking and lung cancer.
On the point about whether the use of video cameras to influence hand hygiene behaviours is the right or wrong approach, you're also being a complete tosser. You have assumed that this is seen as some kind of Orwellian view. But it's the implementation that counts. It turns out that actually, most hospitals using this technology are using it to help staff learn how they actually behave, compared to how they think they behave. Because most staff tend to believe they wash their hands consistently, and most staff don't, due to cognitive overload and other factors. So it is in fact a *learning* tool, not a coercive tool. As well as reading the Checklist Manifesto, you need to read Gawande's article on spreading innovation, which talks about the use of remote coaching in healthcare.
http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande
This isn't about bad micro management, it's about putting systems in place to help humans achieve 100% reliability, which is innately difficult for us.
I patronised you because you acted as though you had all the answers, when you clearly haven't remotely researched the topic. This isn't about malicious compliance. It's about you having a preset narrative that you wanted to impose on the story, even when the facts do not support your narrative.
Gawande traces the history of checklists. He starts with surgery but expands the applications well beyond there. His work to push the takeup of checklists is amazing, and will save many lives.
Time pressure is a problem across the entire developed world, but it's not the major driver of failures in reliability. The major driver is the cognitive complexity of the task. Checklists tend to *save* time, not take time, because you don't have to try to remember what to do next, and because they drive towards a more standardised approach.
This irritated me enough to do a quick look for pubmed and Cochrane articles:
http://www.ncbi.nlm.nih.gov/pubmed/20088678
I'm going to quote from the Cochrane Review:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005186.pub3/pdf
"Description of the condition In England, 8.2%of patients admitted to hospital develop healthcare-associated infections (HAIs) (Hospital Infection Society 2007). HAIs cause 5,000 deaths and cost £930 million annually (National Audit Office 1998). In the United States (US), an estimated 5% of patients develop HAIs, at a cost of 4.5 billion USD per year. This translates to an estimated two million cases of HAIs per annum, accounting for nearly 100,000 deaths (Klevens 2007). In Canada, an estimated 220,000 HAIs occur each year, with 8,000 related deaths (Zoutman 2003). Infection control experts everywhere are working to identify and correct factors that contribute to these rates. Although hand hygiene has long been regarded as the most effective preventive measure (Teare 1999), numerous studies over the past few decades have demonstrated that compliance with hand hygiene recommendations is poor and interventions are not effective long term."
I suggest you spend some time learning what Cochrane is *before* responding, to ensure you don't make an even bigger public fool of yourself.