Reducing hospital acquired infections (HAIs) significantly is possibly simply through better adherence to hand washing standards by clinical staff. However, making a hand-washing initiative stick is difficult because people naturally tend to become less adherent to standards over time without a culture that positively reinforces the standard, according to experts from Ohio’s MetroHealth Medical Center, University Hospitals and the Cleveland Clinic.

“The most effective intervention is having a culture within your organization that allows [hand-washing monitoring] in a non-punitive fashion, with peer-to-peer interaction," said Thomas Fraser, vice chairman of the Department of Infectious Diseases at the Cleveland Clinic and medical director for infection prevention for the Clinic's main campus in an article for the local paper, the Cleveland Plain Dealer.

After MetroHealth hired four hand-washing monitors, its compliance rate in its various clinical units rose to more than 97.6 percent. It also said it lowered central line-associated bloodstream infections by 35 percent, ventilator-associated pneumonia by 71 percent and surgical site infections by 64 percent from its rates in 2010.

University Hospitals, for its part, has hospital leadership do periodic random monitoring of hand washing and has a culture where anyone can by raising their hand quietly and non-confrontationally remind a colleague of the hand-washing standard.

The Cleveland Clinic uses infection prevention champions on each ward or floor that monitor adherence to hand-washing standards and answer questions.