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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Wash or pay: Hospital goes to hand-hygiene fines

Money talks when it comes to infection prevention, particularly if it’s coming out of your wallet. That appears to be the lesson thus far of an infection control policy taken to an unusual extreme.

As of this writing, a punitive policy in place at the University of Pittsburgh Medical Center (UPMC) – a vanguard institution in infection prevention – calls for fines of up to a $1,000 for physicians who ignore a hand washing edict. Second offenses could mean a temporary loss of hospital privileges. With varying fines for other health care workers, the policy was enacted amid a persistent outbreak of multidrug resistant Acinetobacter baumannii (MDR-Ab).

How did we come to such a place, we ask rhetorically, knowing full well many infection preventionsts will answer, “Well, we’ve tried everything else!” But are such punitive approaches counterproductive, breeding worker resentment in the name of patient safety?

Surprisingly there has been little “pushback” thus far, in part because no fines have had to be levied, explains Carlene Muto, MD, MS, UPMC's medical director for infection control.

“We’ve had the support of our entire team – our physicians, our nurses, our [administration] and medical executives,” she says. “I think people want to do the right thing. They intend to do the right thing, but for lots of reasons they don’t. They are in a hurry; they didn’t see the sign, whatever. But they get it – they know these organisms are very problematic and that patients can die from them. We just needed something to bring it home.”

And make no mistake, the system was set up with every intention of follow-through on the first offense.

“This fine thing – there’s been a lot of talk over the years about whether the carrot or the stick is better,” she says. “We’ve tried a lot of things with rewards, and I do think it gets you some improvement in behavior. But the bottom-line is we want the right behavior every time.”

For more on this story see the April 2011 issue of Hospital Infection Control & Prevention