Jeanette Smyth has spies watching to make sure doctors, nurses and therapists at Ogden Regional Medical Center wash their hands.
At the low point, half weren't practicing good hygiene. Today, the shirkers are down to about 10 percent, according to the hospital's infection control and prevention specialist.
And that has translated into fewer cases of the health-care-aquired infection known as MRSA, or methicillin-resistant staphylococcus aureus, too.
Smyth's secret auditors "walk up and down the hall and pretend they're doing other things with the clipboard. If you're watched, your compliance goes up," she said. "If the compliance is down, they hear about it. This is a never event: We never want them not to wash their hands."
Ogden Regional is one of three Utah hospitals working with the federal government to track and reduce the spread of MRSA. The others are University of Utah Hospital in Salt Lake City and Uintah Basin Medical Center in Roosevelt.
The federal government set requirements for a certain number of hospitals in each state to sign onto the effort. Utah was required to find two and instead signed up the three, according to HealthInsight, which is helping with the project as Utah's quality improvement organization contracted through Medicare.
Hospitals are not required to report MRSA cases. But these three hospitals agreed to report their infection rates to the Centers for Disease Control and Prevention's National Healthcare Safety Network.
"We're committed to improving patient care. We see this as an opportunity to reduce MRSA infections," said Jeanmarie Mayer, an infectious disease doctor and a U. hospital epidemiologist.
MRSA is resistant to antibiotics that are usually used to treat staph infections. It can cause a range of problems, from skin infections that look like spider bites to bloodstream infections, surgical-site infections, pneumonia and death. An estimated 94,000 people are infected with the bacteria each year, with 19,000 deaths, according to the CDC.
Patients are at risk if they have weakened immune systems or undergo invasive medical procedures.
MRSA, which is present in the community, is most commonly introduced to hospitals by patients who already have an infection or carry the bacteria but have no symptoms. And it is passed from patient to patient mainly on the hands of health care workers.
The U. will focus on MRSA infections in the intensive care unit, addressing good hand hygiene, environmental cleaning and communication, Mayer said. For example, the hospital is shadowing nurses to see what systemwide changes need to be made, such as making alcohol sanitizer more accessible in patient rooms.
It may monitor housekeeping staff by tracking whether an invisible substance has been washed. And it will work on ways to reduce the risks of transmission when MRSA-infected patients -- who are isolated in their rooms -- are moved to other areas of hospitals for care.
As part of the national hospital chain Healthcare Corporation of America, Ogden Regional has been working on reducing MRSA infections since 2006. In addition to the so-called "secret shoppers," the hospital has installed alcohol hand sanitizers inside and outside every patient room and at the hospital entrance. Signs in patient rooms urge them to ask their caregivers to wash their hands.
The hospital audits how much sanitizer, soap and gloves are used.
At the beginning, physicians washed their hands the least, Smyth said. It's taken time, but she believes the hospital culture is changing. But not the community.
"I watch [people] in the airport," she said. "They play in the water -- they don't wash their hands."
