NY Hospital Installs Hand-Washing Cam | Guest Blog

A New York hospital has resorted to videotaping staff to monitor hand-washing. Why not investigate the reasons for non-compliance instead?

Doctors and nurses in the ICU at Long Island’s North Shore University Hospital are being watched by 39 video cameras in an effort to increase compliance with hand washing. According to a report, hand-washing compliance is up from less than 10% to 90% since the program started.

Cameras are positioned near the doors of patient rooms and at sinks. Patients are not being videoed. The real-time feed is observed by workers in India. Staff failure to wash hands is noted, and the results are posted on electronic bulletin boards in the unit. So far, miscreants are simply talked to.

“No one’s been fired, no one’s been written up, but there have been one-on-ones,” the news story says and, “Infections have decreased though an exact percentage was unavailable.” That raises the question: How they would know if infections have really decreased if the exact percentage is unavailable? And here’s another question: “Is the decrease statistically significant?”

This venture, while well-intended, seems like a bad idea to me. I suppose you are thinking, “Could Skeptical Scalpel really be against hand washing?” Well, I’m not. But what seems logical and correct sometimes may not be. For example, everyone knows that sinks with faucets that have electronic eye sensors are cleaner and better to use in hospitals than sinks with manual faucets, right?

A study presented at a meeting of the Society for Healthcare Epidemiology of America last year by a group from Johns Hopkins concluded the following:

“Electronic faucets were more likely to become contaminated with Legionella spp. (species) and other bacteria after water system disruption. Electronic faucets were less likely to be disinfected after chlorine dioxide remediation. Electronic faucet components may provide points of concentrated bacterial growth. These findings led to removal of all electronic faucets from clinical areas in our institution. [Emphasis added.]

Washing hands with soap and water may cause dryness and irritation resulting in skin breakdown. It may be that constant, obsessive hand washing and use of gels could promote the emergence of resistant organisms.

Another potential issue with the video observation is a false accusation of failure to wash. Patient rooms and patients themselves are not being watched. Let’s say a nurse went into a patient’s room to tell him something and didn’t touch anything. A person in India watching a video from a camera focused on a door or sink would not be able to tell that. If the nurse doesn’t wash her hands when she leaves the room, is she going to be cross-examined?

And what about cost? How much does it cost to install and maintain 39 video cameras, stream the video to India and pay people there to watch the monitors and feed back the information 24 hours per day? Remember, they have no proof that video surveillance reduces infections.

What does this scheme say about the relationship of the professional staff to the hospital’s administration? More problematic is the fact that even though they know they should, doctors and nurses at a major medical center apparently cannot be trusted to wash their hands unless they are spied upon. What else do they not do?

Instead of issuing press releases about this ill-advised program, hospital management might want to consider investigating why their staff is non-compliant.

Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For 2 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 250,000 page views, and he has over 3,300 followers on Twitter. 

  • Megan says:

    um, how about if you need to urinate, then you wash your hands, and then proceed to walk into a patient’s room? oh, i guess they will just have to put cameras in the bathroom too!

  • SkepticalScalpel says:

    Megan, thanks for commenting. The story about this specifically says, “Patients are not filmed and no toilets are ever seen,” but maybe your suggestion is the next step.

    I posted a link to this post on my own blog site. Here’s a comment by WakingUpCosts, who said…

    “Our hospital is encouraging patients to report ‘doctors’ who don’t wash their hands. Not other hospital staff. Just doctors. Nice.”

  • RobertL39 says:

    So, in your opinion, what ARE the reasons for non-compliance? Horrible problem. Locally compliance rates vacillate majorly, with doctors being the least compliant [Surprise!!]
    How about… alcohol-based rub dispensers on each side of the doorway to a patient room. On doorway, a motion sensor connected to an alarm, which can be de-activated only by using the handrub.

  • SkepticalScalpel says:

    That’s a good question. I’m not a psychiatrist so I can only guess. Doctors think they are immune to carrying bacteria? They are arrogant? They are “too busy”? They are lazy? Maybe someone should survey doctors to see why,

    Your idea isn’t bad but as I said in the post, there are times when one goes into a room and doesn’t touch anything. And it wouldn’t work for C diff as alcohol doesn’t kill it.

    • RobertL39 says:

      In this situation, in contrast to other parts of medicine, I suspect overtreatment [having to use the rub when you don't 'need' to] is better than undertreatment. No harm done. And fecal bacteria transplants may markedly reduce the C diff problem. Plus, perhaps fewer nosocomial infections would mean fewer, and hopefully better-targeted, antibiotics and thus less C diff. Headline: “Handrub use markedly reduces C Diff infections”

  • Karen RN says:

    Why non-compliance? How much time do you have? Laziness, arrogance (read some time ago that the the white coat and the MD’s tie were filthy with bacteria), lack of respect for the patient (if the patient’s life is of no concern…). Caring about the man/woman/child in the bed is the first step – afterall there would be no jobs without the patient.

  • SkepticalScalpel says:

    Overtreatment is not always better. Look at the emergence of resistant organisms due to overuse of antibiotics. I would say overuse of hand gel could more likely cause bacterial resistance than eradicate C diff.

  • SkepticalScalpel says:

    Karen RN, your comment just came to my attention.

    As I said at the end of the post, I agree that it would be interesting to find out why doctors are non-compliant. Yes, white coats and ties have bacteria on them. So do the uniforms/scrubs that nurses wear. None of these clothing associated bacteria have been linked to disease transmission. And one does have to wear some sort of clothing.

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  • Morton I. Goldstein M.D. says:

    Regarding skin breakdown with repeated handwashing, I have found a a simple inexpensive cure for the hand Eczema which plagued me for many years after med school.

    Now handwashing or alcohol sanitizers are no problem but I avoid dish soaps which advertise hi power “degreasers”.

    I hope in the near future to find a collaborator either a company or group or individual to find a way to prove this and get it to market.The multimiliion dollar research labs of the big companies have missed this.

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