Building a New SuperTool to Prevent Hospital-Acquired Infections

Over the past few years there has been a huge push across the country to reduce healthcare associated infections (HAIs).

This has created a big market for entrepreneurs. In fact, according to BCC Research the market for HAI prevention products is expected to be $14 billion by 2016, at which time the market for antibiotics to treat HAIs is expected to be only $6 billion. Some hospitals have purchased high-tech hand hygiene monitoring devices that use radiofrequency identification, some have installed video cameras to observe hand hygiene, while others have invested in hydrogen peroxide robots.

At my hospital we’re investing in coat hooks.

As we prepare to roll back contact precautions (i.e., no longer requiring patients with VRE or MRSA to be isolated except in special circumstances), we thought it would be good to re-visit bare below the elbows to reduce clothing contamination and promote good hand hygiene.

Several years ago, our infection control committee endorsed the bare-below-the-elbows concept. This means short sleeves, no neck ties, and no white coats. We specifically crafted our policy as a recommendation not a mandate since we believed there was enough evidence to recommend this intervention but not enough to require it. It was an intentional soft sell. Since the recommendation was made we have seen more physicians in scrubs, and our nurses are nearly all in scrubs. We still have the issue of long sleeves under scrubs when the weather is chilly, and we still have many doctors who just can’t ditch the white coat.

So our latest effort, the “Hang it up” campaign, is a little more pragmatic, giving healthcare workers more options to comply with bare below the elbows. We’re placing coat hooks in all physician team rooms and nurse work rooms with a poster (the physician poster is shown below) asking healthcare workers to hang up their jacket or white coat before going to see a patient. If a male doctor feels compelled to wear a necktie, we advise him to tuck it in his shirt.

We would have preferred to have coat hooks placed between patient rooms on wards, but fire regulations wouldn’t allow that.

As I have said before, the longer I work in infection prevention, the more I believe it’s a behavioral science. Old habits die hard, so the next few months should be quite interesting to observe.

Mike Edmond is a physician and hospital epidemiologist at Virginia Commonwealth University Medical Center in Richmond, VA. This post originally appeared at a blog he co-authors, Controversies in Hospital Infection Prevention.


7 replies »

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  2. Large hospitals are breeding grounds for MRSA and other HAIs. While good hygiene practices are crucial, the way these infections are treated needs to change. Current methods only further the advancement of resistance in these organisms. Natural germicidal substances however, such as Manuka honey, (which kills MRSA) do not have this effect and can be used safely.

  3. Yeah, I totally agree with you there Pinak. I noticed though why less and lesser doctors wear their lab coats when doing their routine check up.

  4. ya it’s currect……. healthcare associated infections (HAIs) is tell in bbc but in this clear way you are explained…..

  5. Hospital-acquired (nosocomial) infections, whether they are caused by bacterial or fungal microbial agents, can be detected early in patients using portable electronic devices to check the effectiveness of preventative hygiene products (tools) and practices.


  6. given the numbers we have on people who use mobile devices in places they shouldn’t (subways, bathrooms, TB clinics) they should probably be a concern here

    there’s probably room for a campaign focused on awareness and best practices not to mention a good study on what’s going on here

    any takers?

  7. I actually haven’t seen a lot of physicians wearing their white coats in a hospital/ clinic setting, especially with younger physicians (except for attendings, though). Another beast to tackle is making sure docs swab their stetho’s after physicals. I’ve seen too many docs skip out on cleaning both diaphragms just because there aren’t alcohol wipes on hand.