It will never cease to amaze me that nearly every health care conference has to have a session on hand hygiene. It is 2011 and we still talking about how to get clinicians to wash their hands before and after touching a patient. Amazing.

But, of course you don't have that problem, right? You have 100 percent compliance. Well, that's what Norma Norton, R.N., director of nursing at Higgins General Hospital, thought. Because the critical access hospital, which is located 48 miles outside of Atlanta, had zero hospital acquired infections, top brass assumed that hand hygiene wasn't a problem. So they were stunned to learn that their baseline compliance was a paltry 20.5 percent.

Sadly, that disparity between belief and reality is pretty common. About two years ago, the Joint Commission Center on Transforming Healthcare launched a program with eight large hospital systems to look at ways of improving hand hygiene. These were big time players in health care—Hopkins, Cedars-Sinai, Trinity. Baseline at those institutions was under 50 percent, according to Melody Dickerson, R.N., who runs the center's hand hygiene program.

Norton and Dickerson spoke during a sunrise (really, pre-sunrise) session on how to improve hand hygiene. Dickerson explained how the center's program, which has since been extended well beyond the initial sites, provides tools for gathering data, assessing the problem and implementing best practices to improve performance.

Higgins General is an excellent example. The hospital instituted a system of "secret shoppers" where fellow staff essentially spied on others to see if they were washing their hands. A few problems were identified: for instance, some people thought that just putting on gloves was just as effective. Also, hand sanitizer dispensers were not located in the best, most convenient places. The hospital made some changes, improved staff training and as of last November, compliance was up to 74 percent.