UW Medicine as part of the Access to Excellence quality improvement process encourages proper hand hygiene before and after direct patient care contacts. At Harborview Medical Center, there are clear trends showing that when overall rates of hand hygiene in the hospital improve, rates of hospital acquired methicillin resistant staphylococcus aureus (MRSA) infections experienced by patients decrease. Similarly, in months when hand hygiene rates are not as good, infection rates rise. UW Medicine monitors and reports monthly rates of hand hygiene by hospital, department, and clinical service units on the Patients Are First dashboards. In 2013, UW medicine established financial incentives for departments meeting or exceeding the hand hygiene targets. For the 2013-14 academic year, our department was one of two departments not meeting the target. The goal for hand hygiene is currently set at 98% for inpatient areas and 100% for outpatient clinical areas. Monitoring has moved from a composite measure including amounts of hand gel and soap used to direct observation.

There are certainly obstacles to routine use of hand gel on psychiatry inpatient psychiatry units and hand hygiene is probably newer to outpatient psychiatry practice than to other medical outpatient settings. Safety concerns regarding direct patient access to alcohol gel on inpatient units meant that inpatient psychiatry units have been the last units to get significant numbers of gel dispensers and some units still do not have adequate supplies for staff to “gel in and gel out” when entering and leaving patient rooms. Yet, from an overall patient experience and safety standpoint, proper hand hygiene will protect patients from any number of infectious disease problems even it MRSA rates are lower in psychiatry than other settings. Recent outbreaks of norovirus and influenza that spread amongst psychiatry patients and staff this year are good reminders that proper hand hygiene protects everyone. As of May 1st, our department has met the 98% hand hygiene goal three of the prior 10 months. We have made improvements from last year but still have much work to do and so everyone is encouraged to practice good hand hygiene “with every patient, every time.”