To encourage hospital workers to maximize "hand-hygiene compliance," Silka and his colleagues decided to take action. They distributed bottles of alcohol-based hand sanitizer every morning. They even took a page from the Wild West, creating what they called a "posse" of hand hygiene sheriffs.
"We'd try to capture the physicians on rounds, and in a friendly way, encourage them to wash their hands," said Silka. If we saw somebody washing their hands, we would reward them." Doctors who followed the hand washing guidelines received rewards, like Starbucks gift cards.
But it wasn't enough, said Silka. "Ultimately, we had to give physicians a visual example, from a microbiological standpoint, of what their hands would look like if they didn't wash."
So, they set up a simple science project.
The hospital's epidemiologist, Rekha Murthy, asked colleagues to press their hands into petri dishes and sent them to a lab for processing. The level of contamination shocked the staff. The petri dishes "looked nasty," said Silka.
But the experiment worked. Cedars-Sinai administrators turned the germ-laden petri dishes into the hospital's computer screen saver, forcing staff constantly to look at the images.
"Doctors saw this image of this disgusting pathogen-filled hand and that was the trick that, for whatever reason, made them respond," said Dubner. "It was so successful that not only did it make Cedars-Sinai hand hygiene improve to almost 100 percent, but hospitals around the country started to copy the solution."
Dubner adds that best solutions are often the most cost effective and straightforward. "Washing hands is one of the simplest fixes" to improve hospital-acquired infection rates, Dubner said.
But even freshly washed hands are no match for common, dirty objects, like keyboards and door knobs. "That's why sometimes design and technology offer the solution, and there are things you can do in hospitals to stop bacteria from spreading that go beyond washing hands," he said.
Cedars-Sinai Medical Center takes extra steps to avoid contamination by training its cleaning staff to focus attention on objects like bed rails, bedside telephones, tables and chairs. Curtains separating patient beds are made from special anti-bacterial fabrics, and some patient rooms feature "negative pressure" ventilation systems that keep contaminated air from being recirculated throughout the hospital and causing new infections.
In the war against hospital infections, even something as innocent as the necktie is a target. A study from New York Hospital showed that almost half of doctors' neckties carried germs, and one out of four carried potentially harmful staph bacteria. In fact, the United Kingdom's Department of Health has banned doctors from wearing neckties, watches and jewelry.
Banning neckties and scaring doctors with graphic screen savers may seem over the top, but for patients like Cole, living with the consequences of hospital-acquired infections, there's no such thing as too much vigilance. While still struggling with the physical aftermath of her near-fatal infection, she has devoted her life to helping other patients avoid hospital infections. (Click here for more information).