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These hands were made for washing

Toronto, October 16, 2014

By James Wysotski


Sophia Wong sings These hands were made for washing at the 14 CC nursing station.

With mike in hand, registered nurse Sophia Wong flips on the PA system. She’s live. Although small in stature, her voice booms. It helps that speakers amplify her across St. Michael’s largest unit, 14 Cardinal Carter.

“This is a reminder that clean hands are healing hands,” Wong said.

While her daily overhead announcements bring the floor to a halt, it’s her adaptation of Nancy Sinatra’s These Boots are Made for Walkin’ that’s the showstopper.

“These hands are made for washing,” Wong sang in an impromptu video circulating on the unit, “and that’s what we will do, because one of these days these hands gonna do vital signs on you.”

For a unit looking to increase its hand hygiene compliance rates, the message couldn’t be more on point.

“Whatever you're doing, you have to stop and listen because it's just so engaging,” said Shirley Bell, the interim clinical leader manager of General Internal Medicine on 14 CC, as she pulled out a plastic hand-clapping device. It’s a rule that staff have to clap whenever they hear the announcements.

The engagement Wong’s song elicits has helped staff on 14 CC buy into what their interdisciplinary hand hygiene committee has instructed since forming in July 2013 when compliance rates for before patient contact – Moment 1 of 4 – were a dismal 30 per cent; the hospital’s target is 65 per cent. Former St. Michael’s registered nurse Qasim Mohiuddin, the committee’s head at its inception, said the staff “is so busy in their tasks that sometimes they need friendly reminders to help them remember to wash their hands.”

Now headed by Wong, the committee identified barriers to success, such as too few hand sanitizers in less-than-optimal positions, and immediately began addressing the issues. Bold signs emblazoned with “Stop, wash your hands” went up in highly visible locations across the unit. Sanitizers were attached to every workstation. There was no escaping the reminders.


Samples of 14CC’s daily announcements,
tailored to be catchy, positive and inspiring:

  • Clean hands are caring/healing hands
  • A journey of caring starts with your clean hands
  • Show your passion of caring by washing your hands
  • Let’s save patients with hand hygiene
  • What’s the cheapest way to stop the spread of germs
  • Let’s create a culture of caring by washing our hands

While these changes helped, audits showed it still wasn’t enough.

“It was hard to get buy-in initially because everybody was convinced they were washing their hands,” said Bell. “How could you work here and not wash your hands?”

It wasn’t until Mohiuddin trained as an auditor that change kicked into high gear.

“The key for [staff on 14 CC] was to trust the system, to show them that the auditing process does work,” said Mohiuddin, who spearheaded education sessions designed to address confusion and ambiguity surrounding what qualifies as Moment 1.

Now, reporting hand hygiene is incorporated into nurses’ transfer of accountability. Plus, everyone’s encouraged to approach colleagues and physicians with reminders to wash hands. The trick, said Bell, is to “ask a question as opposed to making a statement.” It’s friendlier and less disciplinary. And it works.

By September 2014, Moment 1 compliance rates rose to 43 per cent. Moment 4 (after patient contact) rates saw similar gains, jumping from 46 to 65 per cent. While they still haven’t hit the Moment 1 target, nobody’s throwing in the towel.

As for Wong, she made an encore sung to The Guess Who tune These Eyes. With a quiver in her voice and arms outstretched to a sanitizer, Wong sang, “These hands are crying out for you.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.