It's no secret that one of the most effective ways to prevent transmission of the flu is by insuring that emergency clinicians and staff are rigorously washing their hands; however, maintaining compliance with this practice is difficult in a busy emergency setting. Nonetheless, administrators at Henry Ford Hospital in Detroit, MI, have made significant strides in this area by regularly having "mystery observers" pose as visitors to patients in the ED just to check up on how compliant clinicians and staff are with recommended hand-washing practices.
The assignment is entirely an inside job, notes Joyce Farrer, RN, MSN, the administrator of emergency medicine in the Henry Ford Health System. "We are a four-hospital system and we have 51 clinics, so we share staff on the infection control committee," she explains, noting that it is not hard to find a staff person from within the system who can perform the mystery observer duties without being recognized.
"We are pretty slick in how we do it," says Farrer, explaining that either she or one of her managers typically provides the mystery observer with the name of a patient who is currently in the ED. When the observer, posing as a visitor, tells the front desk he or she is there to see the patient, the front desk simply directs the observer to where the patient is being treated. This stealth approach provides the observer with an opportunity to check up on whether staff members are rigorously washing their hands without staff knowing when or where they are being scrutinized.
After four years of utilizing the mystery observers, it is clear that the approach works. "When we first started, our compliance rates were around 75% ... and we are now hitting around 92%," notes Farrer. "We post the results so that there is a kind of competition between groups, and we have huddles twice a day where we are reminding staff to wash their hands."
Administrators also regularly seek staff input on how to boost compliance further through the hospital's practice counsel, a panel comprised of staff members who are elected by their colleagues. "We have [the practice counsel] tell us where we need to put more hand sanitizers, and then housekeeping is responsible for making sure that hand sanitizers are always available," explains Farrer. "The housekeeping supervisor monitors to make sure that hand sanitizer is always well-stocked [in all of the preferred locations]."