At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.
This Big Brother-ish approach is one of apanoply of efforts to promote a basic tenet of infection prevention, hand-washing, or as it is more clinically known in the hospital industry, hand-hygiene. With drug-resistant superbugs on the rise, according to a recent report by the federal Centers for Disease Control and Prevention, and with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything to reduce the risk of transmission.
Studies have shown that without encouragement, hospital workers wash their hands as little as 30 percent of the time that they interact with patients. So in addition to the video snooping, hospitals across the country are training hand-washing coaches, handing out rewards like free pizza and coffee coupons, and admonishing with "red cards." They are using radio-frequency ID chips that note when a doctor has passed by a sink, and undercover monitors, who blend in with the other white coats, to watch whether their colleagues are washing their hands for the requisite 15 seconds, as long as it takes to sing the "Happy Birthday" song.
All this effort is to coax workers into using more soap and water, or alcohol-based sanitizers like Purell.
"This is not a quick fix; this is a war," said Dr. Bruce Farber, chief of infectious disease at North Shore.
But the incentive to do something is strong: under new federal rules, hospitals will loseMedicare money when patients get preventable infections.
One puzzle is why health care workers are so bad at it. Among the explanations studies have offered are complaints about dry skin, the pressures of an emergency environment, the tedium of hand washing and resistance to authority (doctors, who have the most authority, tend to be the most resistant, studies have found).
"There are still staff out there who say, 'How dare they!' " said Elaine Larson, a professor in Columbia University's school of nursing who has made a career out of studying hand-washing.
Philip Liang, who founded a company,General Sensing, that outfits hospital workers with electronic badges that track hand-washing, attributes low compliance to "high cognitive load."
"Nurses have to remember hundreds — thousands — of procedures," Mr. Liang said. "Take out the catheter; change four medications. It's really easy to forget the basic tasks. You're really concentrating on what's difficult, not on what's simple."
His company uses a technology similar to Wi-Fi or Bluetooth. The badge communicates with a sensor on every sanitizer and soap dispenser, and with a beacon behind the patient's bed. If the wearer's hands are not cleaned, the badge vibrates, like a cellphone, so that the health care worker is reminded but not humiliated in front of the patient.
Just waving one's hands under the dispenser is not enough. "We know if you took a swig of soap," Mr. Liang said.
The program uses a frequent-flier model to reward workers with incentives, sometimes cash bonuses, the more they wash their hands.
Gojo Industries, which manufactures the ubiquitous Purell, has also developed technology that can be snapped into any of its soap or sanitizer dispensers to track hand-hygiene.
At North Shore, the video monitoring program, run by a company called Arrowsight, has been adapted from the meat industry, where cameras track whether workers who skin animals — the hide can contaminate the meat — wash their hands, knives and electric cutters.
Adam Aronson, the chief executive ofArrowsight, said he was inspired to go from slaughterhouses to hospitals by his father, Dr. Mark Aronson, vice chairman for quality at Beth Israel Deaconess Medical Center in Boston and a professor at Harvard Medical School.
"Nobody would do a free test — they talked about Big Brother, patient privacy — nobody wanted to touch it," Mr. Aronson said.
He finally got a trial at a small surgery center in Macon, Ga., and in 2008, North Shore also agreed to a trial in its intensive care unit. The medical center at the University of California, San Francisco, is also using Arrowsight's video system, and Mr. Aronson said eight more hospitals in the United States, Britain, the Netherlands and Pakistan had agreed to test the cameras.
North Shore's study, published in the journal Clinical Infectious Diseases, found that during a 16-week preliminary period when workers were being filmed but were not informed of the results, hand-hygiene rates were less than 10 percent. When they started getting reports on their filmed behavior, through electronic scoreboards and e-mails, the rates rose to 88 percent. The hospital kept the system, but because of the expense, it has limited it to the intensive care unit, where the payoff is greatest because the patients are sickest.