The American Journal of Infection Control recently published a study on hand hygiene compliance (HHC) among healthcare workers. Here are some key findings from the report:

  • Hand hygiene compliance was 91% for health workers observed overtly.
  • For workers who were observed covertly, hand hygiene compliance was 49.3%.
  • HHC based on covert observation increased to 66.9% after an intervention.[i]


To paraphrase Catwoman from the 1960s Batman series, when will we as a country stop pussyfooting around, Batman?[ii]

We as a country should not accept anything less than 100% compliance.  Why? People could die.  A patient could get sicker.  A simple situation could get worse.  Someone could get MRSA and die.  My own father ended up spending three extra weeks in the hospital because he contracted a MRSA-like infection which almost killed him. Between 2000-2010, hospital death rates declined overall but increased for septicemia.[iii]


Zero tolerance.  How do we get to zero tolerance?  Instead of a pure politically correct world, how about a movement toward firing non compliant employees?  For example, take a nurse who doesn’t comply with hygiene rules.  They get written up and get an honest chance to improve.  The next time they are caught being non-compliant in their life-disdaining habits, they have the choice: a 5% reduction in income or leaving the hospital.  The only way they will earn that 5% back is 100% compliance for a year.  Wow, a penalty?  Yes, a penalty.  They get to keep their job, but if they screw up one more time after that, 5% is irrelevant.  You’re fired, on the spot.  That will get 100% compliance.


What are we doing?  Even after the intervention in the hand washing study, compliance only increased to two-thirds?  How about 100% compliance?


Pass a law.  The law states if someone works in a healthcare environment and does not achieve 100% hygiene compliance, a simple system ensues.  First strike: the employee is written up and re-educated with a goal of 100% compliance.  Misstep again?  Strike two: the employee either loses 5% of their income or is asked to leave the organization, without eligibility for unemployment.  Strike three: fired on the spot for gross/aggravated misconduct.  It will follow them to future employers.


There’s your solution.  Keep it simple solution!  Too harsh?  Grow up.  What if that person with that lack of hygiene caused your child to contract something very serious and die?  Now, is it too harsh?  I don’t think so.


[i] Eunwoo Yoo, et al., “The Effect of Incorporating Covert Observation into Established Overt Observation-based Hand Hygiene Promotion Programs,” American Journal of Infection Control, Volume 0, Issue 0, 2018, via MCOL Daily Factoid email newsletter, 28 December 2018


[ii] Batman, “Hot Off the Griddle,” Directed by Don Weis. Written by Stanley Ralph Ross. 14 September 1966.


[iii] Margaret Jean Hall, Ph.D.; Shaleah Levant, M.P.H.; and Carol J. DeFrances, Ph.D., “Trends in Inpatient Hospital Deaths: National Hospital Discharge Survey, 2000-2010,” Centers for Disease Control and Prevention, March 2013,

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