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."

Comments

Let me be the first to say...

[dgatwood]

Ewww.

Re:Groan

[JDG1980]

But... hang on a bit... how come 20 years ago this wasn't an issue?

Who says it wasn't?

Re:Trust

[JDG1980]

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.

Not well thought out

[girlintraining]

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.

Re:Groan

[Rockoon]

Probably 20 years ago they werent expected to use hand sanitizers, but now they are.

In the environment that I work (a casino), there is frequent contact with chips, cards, and money that have been handled by large numbers of people over short periods of time so illnesses frequently spread. Of course its recommended that dealers and floor/pit men regularly use hand sanitizers throughout their shift, but if you've ever tried to regularly used hand sanitizer then you would know that you cant regularly used hand sanitizer without fucking up the skin on your hands.

Re:Trust

[HockeyPuck]

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...

Re:Groan

[dargaud]

but if you've ever tried to regularly used hand sanitizer then you would know that you cant regularly used hand sanitizer without fucking up the skin on your hands.

I was about to say that. I know several doctors who work in hospitals and the skin of their hands is all dried and peeling off. They are the ones catching basic diseases because the skin of their hands has become too thin from all the washing. I think a future axis of research should be more about maintaining a healthy but innocuous surface bacterial flora. See what is going on right now with fecal transplants !

I loathe the medical "profession"

[SuperBanana]

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?

• We're forced to be seen by inexperienced, sleep-deprived, overburdened, overworked trainees. We don't allow truckers to drive more than X hours in Y days and the medical profession has proven lack of sleep impacts mental abilities. But med student hours? Sky's the limit, and it's common knowledge that you're supposed to fake your timesheets now that hospitals "track" this and have "policies."
• Medication errors cause 1.3 million injuries a year. Let's be clear here: Dr. I-Swore-An-Oath apparently can't be bothered to slow down and PRINT CLEARLY on your prescription form.
• Surgeons routinely fuck up "which leg" or "which eye." They're taught all sorts of anatomy, except they can't seem to figure out "left" versus "right"
• Despite the fact that hospitals are increasingly a cesspool of MRSA and other diseases, we continue to cling to the idea that we should treat people with transmissible diseases in close proximity to others, instead of having doctors travel to the sick patients, treat them, disinfect, and move on to the next patient. Gee, what could possibly go wrong with concentrating sick and weak people in one area?

Re:I loathe the medical "profession"

[MMC Monster]

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?

• We're forced to be seen by inexperienced, sleep-deprived, overburdened, overworked trainees. We don't allow truckers to drive more than X hours in Y days and the medical profession has proven lack of sleep impacts mental abilities. But med student hours? Sky's the limit, and it's common knowledge that you're supposed to fake your timesheets now that hospitals "track" this and have "policies."
• Medication errors cause 1.3 million injuries a year. Let's be clear here: Dr. I-Swore-An-Oath apparently can't be bothered to slow down and PRINT CLEARLY on your prescription form.
• Surgeons routinely fuck up "which leg" or "which eye." They're taught all sorts of anatomy, except they can't seem to figure out "left" versus "right"
• Despite the fact that hospitals are increasingly a cesspool of MRSA and other diseases, we continue to cling to the idea that we should treat people with transmissible diseases in close proximity to others, instead of having doctors travel to the sick patients, treat them, disinfect, and move on to the next patient. Gee, what could possibly go wrong with concentrating sick and weak people in one area?

As a physician I'm quite interested in the subject. :-) Things have been bad in the past, but is getting better on all fronts. Let's take your issues one at a time:

There's a cap placed on residency hours per week and hours in a row, now. Yes, it's sometimes broken, but it's a lot better than 20 years ago. And, no, it's not routine practice to fake your timesheets. Or at least where I trained ~15 years ago, and not in the training program I assist overseeing. That being said, in some subspecialty fellowships I wouldn't doubt that it's more common to do this -- But they do this to gain more experience as you may only get a once in a decade experience if you stay on call and extra 2 hours. Who would deprive themselves that?

Penmanship is not taught in medical school. But electronic perscriptions are becoming more commonplace in the last few years (both on the outpatient and inpatient sides). And the last couple decades have brought on more responsibility of the patient to know what they are taking. The outpatient medication errors are the combined fault of the physician, the pharmacist, and the patient.

I wouldn't say that anyone routinely operates on the wrong body part. But mistakes do happen. It's now standard of care to do a "time out" with the patient, nurse, and physician all in the operating room to agree on the patient's name, date of birth, and procedure to be performed before any sedation is administered or incisions are performed. But I once had a patient respond to a different name who expected to have the same procedure performed. Fortunately he was tripped up by the date of birth.

As for washing hands, that's a culture change. My hospital has random people anonymously assigned to watch people enter and leave patient rooms to make sure we always wash in and out. (The people are people that work on the floors anyway.) A couple verbal warnings and suddenly everyone's compliant. No need for technology.

And the younger generation of physicians are more humble. But that's also because they tread medicine as more of a job and less of a calling. I guess you can't get everything. :-(

Re:I loathe the medical "profession"

[BlueBlade]

Yeah, last time I had surgery, they wouldn't even lead me to any answer. It basically went :

Doctor : Why are you here?
Me : Surgery.
Doctor : What kind?
Me : Eye surgery to correct strabismus.
Doctor : Which eye?
Me : Left.

They didn't just read stuff asking me to confirm it, I actually had to give them the information. I assume this way there's much less risk of a patient just confirming all the surgeon's questions.

Re:Trust

[Jah-Wren Ryel]

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.

Re:Groan

[Anonymous Coward]

Then you should switch type/brands! The use of sanitizer instead of soap and water for dentists and doctors here in Sweden have dramatically decreased skin problems as hand sanitizer in most cases are better in preserving skin moisture than (even mild/re-hydrating) soap. Sure there are brands that doesn't contain re-hydrating compounds and sure there are people just not "compatible" with sanitizers but in general it's a win.

Alcohol bad for skin

[justthinkit]

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.

Re:India ?

[oobayly]

Well, that's great, apart from the fact that I can find only one source of that story (and a huge amount of forums linking to the same story).

I'll google it for you. Not even the Daily Mail has a story with that headline.

I get this kind of shit emailed to me every day from colleagues. I've debunked every single email that I get, and have now set up a rule that deletes any email from certain people that are sent to the office.

The one this morning that I heard about was "Nigel Farrage's - Tory party's worst nightmare". If the man has such great policies, why do his supporters need to attribute thirteen year old diatribes to him?

Re:Groan

[JohhnyTHM]

Spot on. My wife has worked in a hospital for about 12 years. A couple of years ago they switched the sanitiser to a cheaper brand to save some money. After about 2 weeks so many staff were unable to work due to dry/cracked/bleeding/infected hands that the hospital had to hire agency staff to cover shifts. The cost of this and unions getting involved had the old sanitiser brought back in shortly after. They haven't tried swapping brands since then.

Re:India ?

[stdarg]

You didn't do much research! This is a true story from 2010.

http://www.dailymail.co.uk/news/article-1265136/NHS-relax-superbug-safeguards-Muslim-staff--just-days-Christian-nurse-banned-wearing-crucifix-health-safety-reasons.html

http://www.telegraph.co.uk/health/healthnews/7576357/Muslim-staff-escape-NHS-hygiene-rule.html