Superfreakonomics_ global cooling, patri - Steven D. Levitt [92]
In a 1999 report called “To Err Is Human,” the Institute of Medicine estimated that between 44,000 and 98,000 Americans die each year because of preventable hospital errors—more than deaths from motor-vehicle crashes or breast cancer—and that one of the leading errors is wound infection. The best medicine for stopping infections? Getting doctors to wash their hands more frequently.
In the wake of this report, hospitals all over the country hustled to fix the problem. Even a world-class hospital like Cedars-Sinai Medical Center in Los Angeles found it needed improvement, with a hand-hygiene rate of just 65 percent. Its senior administrators formed a committee to identify the reasons for this failure.
For one, they acknowledged, doctors are incredibly busy, and time spent washing hands is time not spent treating patients. Craig Feied, our emergency-room revolutionary from Washington, estimates that he often interacted with more than one hundred patients per shift. “If I ran to wash my hands every time I touched a patient, following the protocol, I’d spend nearly half my time just standing over a sink.”
Sinks, furthermore, aren’t always as accessible as they should be and, in patient rooms especially, they are sometimes barricaded by equipment or furniture. Cedars-Sinai, like a lot of other hospitals, had wall-mounted Purell dispensers for handy disinfection, but these too were often ignored.
Doctors’ hand-washing failures also seem to have psychological components. The first might be (generously) called a perception deficit. During a five-month study in the intensive-care unit of an Australian children’s hospital, doctors were asked to track their own hand-washing frequency. Their self-reported rate? Seventy-three percent. Not perfect, but not so terrible either.
Unbeknownst to these doctors, however, their nurses were spying on them, and recorded the docs’ actual hand-hygiene rate: a paltry 9 percent.
Paul Silka, an emergency-room doctor at Cedars-Sinai who also served as the hospital’s chief of staff, points to a second psychological factor: arrogance. “The ego can kick in after you’ve been in practice a while,” he explains. “You say: ‘Hey, I couldn’t be carrying the bad bugs. It’s the other hospital personnel.’”
Silka and the other administrators at Cedars-Sinai set out to change their colleagues’ behavior. They tried all sorts of incentives: gentle cajoling via posters and e-mail messages; greeting doctors every morning with a bottle of Purell; establishing a Hand Hygiene Safety Posse that roamed the wards, giving a $10 Starbucks card to doctors who were seen properly washing their hands. You might think the highest earners in a hospital would be immune to a $10 incentive. “But none of them turned down the card,” Silka says.
After several weeks, the hand-hygiene rate at Cedars-Sinai had increased but not nearly enough. This news was delivered by Rekha Murthy, the hospital’s epidemiologist, during a lunch meeting of the Chief of Staff Advisory Committee. There were roughly twenty members, most of them top doctors in the hospital. They were openly discouraged by the report. When lunch was over, Murthy handed each of them an agar plate—a sterile petri dish loaded with a spongy layer of agar. “I would love to culture your hand,” she told them.
They pressed their palms into the plates, which Murthy sent to the lab. The resulting images, Silka recalls, “were disgusting and striking, with gobs of colonies of bacteria.”
Here were the most important people in the hospital, telling everyone else how to change their behavior, and yet even their own hands weren’t clean! (And, most disturbingly, this took place at a lunch meeting.)
It may have been tempting to sweep this information under the rug. Instead, the administration decided to harness the disgusting power of the bacteria-laden handprints by installing one of them as