Many of you have likely read the article in Monday's Globe and Mail regarding our plans to acknowledge good hand hygiene practices by giving "well hand cleaned" staff a $2 gift certificate from Tim Horton's. We've received a fair amount of feedback on this strategy from both inside and outside the hospital that can probably be summarized in to two concerns: 1) how can a hospital support unhealthy food? and 2) it is obvious that healthcare workers should be doing this hence any reward strategy is both offensive and a waste of time and money.

First the easy concern: Although the headline talked about Timbits, coupon holders can buy whatever they want at Tim Horton's i.e. we don't control what headline writers write.

The second concern we find worrisome as it confirms something that others have found thoughout the world: namely that we healthcare workers think we are all doing a great job....but the data say we are not. In our UHN audits, less than 40% of us clean our hands before contacting patients. Less than 30% clean our hands before performing an asceptic procedure such as changing a dressing. For every 2 cases of MRSA that we admit to our hospital, we spread it to at least 1 other person. That's right, we spread it and as a group, we are deluding ourselves if we think we are doing a good job. We know that this isn't what our patients expect from UHN and it isn't what we want to do, so we need to work together to change our behaviour.

Patients with MRSA have a 30% chance of developing invasive infections, have a longer length of stay, are more likely to be depressed and lonely, are more likely to experience medical errors, have a harder time moving to rehab, and are more likely to die in hospital.

Giving out a $2 coupon for doing the right thing is akin to giving you a chocolate bar when you get the flu shot. In a world where much of the feedback we receive is about how we should do things better, we want to occasionally reward people for doing the right thing. We would welcome any suggestions that people might have about improving our rate of handwashing.

Coupons are not at the centre of our strategy to bring about permanent improvement: we are putting up alcohol gel dispensers everywhere, educating staff, putting up posters, and auditing performance to feed back to managers. The coupons certainly have drawn attention to a neglected issue though!

If we've offended you with the coupons, we ask that you consider how offensive it is that 12 thousand patients die every year from infections that they acquired in hospitals...that we as healthcare workers spread because the majority of us do not wash our hands appropriately.

Bob Bell 
Catherine Zahn
Kevin Empey 
Michael Gardam​

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