As a physician, I am glad for the mobile health-monitoring applications that allow me to help my patients sleep better, exercise better and eat better. Yet I was a little offended when I learned of a new wristband monitor that prods doctors to wash their hands when they enter a patient’s room.
The bracelet, conceived at the Blueprint Health technology incubator, was introduced by the startup company IntelligentM at the South by Southwest Interactive Festival last month. The device gives doctors and nurses a buzzing signal to wash; it emits further warnings if the cleansing isn’t up to the standards set by the Centers for Disease Control and Prevention. Hospital-infection-control officers can get a buzz from the wristband, too: The technology tracks hand-washing compliance and can share reports with anyone who wants to know.
For those who value their autonomy, the latest practitioner-targeted technologies such as the IntelligentM wristband may be an irritant. But such measures are necessary, however demeaning they seem. In the average U.S. hospital, hand-washing compliance rates vary from just one-third of patient encounters to half at best. And hand hygiene is the single-largest contributor -- and the most fixable -- to the almost 2 million hospital-acquired infections each year that kill 100,000 people in the U.S.
Some public-health researchers say patients should shoulder more of the burden. Why can’t they remind medical professionals to wash their hands? Research shows that’s unlikely to work. Patients may find it awkward or rude to tell their physicians to wash. With reason: In a Swiss study, a third of the doctors and nurses surveyed said they wouldn’t take it well if their patients asked about their hand-washing practices. Some said such an interaction would be humiliating. An even-greater number said they wouldn’t agree to wear a hospital badge asking patients to speak up about hand washing.
All honest doctors and nurses will admit that they have had lapses. We could all benefit from reminders, but asking patients to pick up the slack just exchanges one abysmal compliance rate for another.
Physicians shouldn’t take offense. We all can benefit from reminders about the basics. Years of education and expertise don’t mean that medical professionals aren’t human, and may sometimes forget a step in even routine procedures. The surgeon and writer Atul Gawande has argued for preoperative checklists and recently published his findings that such measures help even during fast-paced surgical emergencies.
I attend meetings every week, some of which recur on the same day and at the same time. Yet without the beep from my phone’s calendar, I would often be late or absent. Similarly, doctors know what they are looking for in the tests they order for patients, but it still helps when lab reports “red-flag” abnormal results. I’m not insulted when the lab publishes the normal range of creatinine alongside my patient’s value, even though I have many years of experience assessing these numbers. I’m not demeaned when the pharmacist calls to ask about a potential drug interaction in a prescription I have written.
A nudge to remember to wash hands should be equally unobjectionable.
Medical professionals are already monitored at all times, with limitations on oversight imposed only by technology. Every position I have held since becoming a doctor has required a drug screening. Publicly accessible Internet databases show that I attended a 2011 dinner hosted by Allergan Inc., the maker of Botox.
Such disclosures will increase as the Sunshine Act gradually takes effect. Eventually, public and private databases will also contain a mention of a lunch I dropped in on recently that was hosted by Ipsen SA, the maker of Botox’s competitor, Dysport. One day, my hand-washing habits could be on the Web, too.
I would like to see employee hand-washing data for the restaurants I frequent, so I cannot begrudge patients and reporters wanting that information about those who work in hospitals and clinics.
Although there are structural limits to how far providers can go in the name of patient safety, the outcomes-focused Affordable Care Act will make doctors and hospitals willing to change practices (and wristwear) if there’s a payoff or a penalty. This financial pressure will change behavior.
Monitoring of my practice behaviors will gradually increase. I can choose to be angry or I can endeavor to understand why these changes are necessary. My advanced degree doesn’t ensure that I will never absentmindedly touch a patient with unclean hands, adding risks and costs our system can ill afford.
(Ford Vox, a doctor at the Shepherd Center for brain and spinal cord injury in Atlanta, writes about health-care policy. The opinions expressed are his own.)
To contact the writer of this article: Ford Vox at firstname.lastname@example.org.
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