Another effective way to promote hand washing compliance is signage. As Ellsworth notes, “It’s a good reminder to wash your hands when it’s in your face.”

Geisinger Health System uses signage in every isolation room that lists all the personal protective equipment required, as well as the importance of hand washing.

“Many nursing units also have graphs on their billboards as a visual reminder to staff of their progress and degree of compliance,” says VanReeth.

Catch phrases, such as “foam in, foam out,” are common on posters and signs in patients’ rooms. And Blanchard Valley Hospital’s hand washing slogan — “gellin’ in, gellin’ out” — is proudly displayed on magnets on the doors of every patient, exam and procedure room.

In addition, signage geared toward patients serves as a reminder for staff, as well. Last year, Blanchard Valley Hospital introduced buttons for nurses to wear on their uniforms with the words “Ask me if I washed my hands,” and a picture of hands being washed. And posters on the walls of patient rooms at Barnes-Jewish Hospital encourage patients to ask employees to wash their hands if they didn’t see them do so.

While some hospitals offer pay incentives to staff to encourage hand washing, environmental services managers interviewed for this article reject this practice.

“Washing our hands is an expected part of what we do and not something people need to be rewarded for,” says Ellsworth.

Barnes-Jewish Hospital tried offering incentives for units with poor hand hygiene compliance.

“We gave immediate feedback, such as a gift card to the cafeteria for people who performed hand hygiene or a red ticket for those that didn’t,” says Couch. Unfortunately, the program did not have much impact on hand hygiene compliance rates and was abandoned after several months.

Despite some setbacks, hospitals appear to be on the right track. Environmental services managers state that hand hygiene compliance rates have improved since they first started implementing hand hygiene programs. In 2009, Geisinger Health Systems’ hand hygiene compliance rate was 84 percent. For fiscal year 2013 to 2014, all nursing units were either at 99 or 100-percent compliance.

“People in healthcare try to help people — it’s just that not everybody has the correct habits,” says Abrams. “We need to constantly observe and listen to patients and healthcare workers. For instance, placement of hand gel is important. If it’s not convenient they’re not going to use it, so we’ve had to relocate some of our hand sanitizer. Most people will do what they’re required to do if we remind them, get them in the habit, and make it convenient for them.”

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