How do you respond when you see a failure of policies and procedures?

For hand hygiene in my institutions if it is noticed that some one has not washed their hands the expected interaction is

“Foam please.”

Then the expected response is to foam and say “Thank you.”

As a system we recognize that during a busy multi-tasking day foaming can be forgotten and it is everyones job to nicely remind each other to do the right thing. It is an approach that appears to work at my hospitals, although it took a lot of groundwork. I talked to every physician group in our hospital in advance so that we could nip in the bud any butt head doctor who wanted to throw a hissy fit when reminded to foam. And yes, there are those doctors.

Sometimes, though, I witness a more egregious failure of infection control, with HCW’s ignoring the the isolation signs on the door. Over the years I have seen some interesting failures of adherence with isolation practices at the 7 hospitals I can cover. Since we are supposed to be nice and respectful to each other, I usually point out the failure to comply and gently re-enforce our policies. I am deliberately being vague as to what, when and where as the specifics are not important. I bet every ID doc and IC practitioner can come up with some horror story of people failing to follow isolation guidelines.

This got me thinking.

We have known about the efficacy of hand hygiene for 150 years.

We are 15 years into the MRSA/MDRO era, sliding slowing into the post-antibiotic era.

We know that we can spread resistant organisms in the hospital.

We know that when patients acquire resistant organisms they are more like to get an infection from that MDRO and die. Let me repeat that.

People die from the bacteria we give them.

We know that proper adherence to infections control practices results in a decrease in the spread of organisms, a decrease in infections, and a decrease in death. Let me repeat that.

Proper infection control prevents death.

We know that the above information is widely and consistently disseminated and available. Everyone knows it.

Similarly.

We know that drinking makes for bad motor skills.

We know that drinking and driving increases the rates of car accidents and death.

We know if you do not drink and drive, it decreases accidents and deaths.

And we know that the above information is widely and consistently disseminated and available. Everyone knows it.

So is there difference in fundamental behavior between someone who does not follow infection control procedures and a drunk driver? Not really.

I can think of two differences. When a drunk driver kills someone, you know exactly when it happens. You never know when and which HCW passes on a fatal infectious disease.

And compared to hospital acquired infections, drunk drivers are amateurs. Drunk drivers kill 10,000 a year in the US and alcohol is involved in 700,000 accidents.

Hospital acquired infections? 1,700,000 a year with 98,000 deaths.

Poor infection control helps kill ten times the number of people that drunk drivers do.

At least you can argue that alcohol ruins peoples judgement; what is the excuse for the HCW who ignores the isolation sign for an MRDO? In the year 2014 I cannot think of a legitimate reason.

I think that may be my new rant (or as my kids call it, a meme) for infection control: failure to comply is worse than drunk driving. It is more like drinking and driving. While texting. At night. On a curving road. Going 75. In the sleet.

If you are a patient, a family member or a HCW and you witness a failure of infection control, remember you are seeing behavior far more dangerous to you, your loved one, and your patient than drunk driving. You might mention it to someone.