RUB AND SCRUB The Joint Commission will cite a facility if a surveyor observes individual caregivers practicing poor hand hygiene.

The Joint Commission's new zero-tolerance policy for poor hand hygiene is as strict as it sounds: You'll be dinged if a surveyor spots even a single staff member not washing her hands when and as she should. The one-strike-and-you're-cited initiative, which went into effect Jan. 1, applies to both hospitals and ambulatory surgical centers.

"Any observation by surveyors of individual failure to perform hand hygiene in the process of direct patient care will be cited as a deficiency resulting in a Requirement for Improvement (RFI) under Infection Prevention and Control (IC) Standard IC.02.01.01, EP 2," reads the Joint Commission update on hand hygiene noncompliance.

Since 2004, the Joint Commission has required facilities to implement — and improve compliance with — a hand hygiene program. The accreditation organization points out that its handwashing standard hasn't changed — only how surveyors are now evaluating the standard.

"Before you'd be cited for a deficiency if the surveyor saw a pattern of [hand hygiene] noncompliance," says Michael Kulczycki, the Joint Commission's executive director of ambulatory care services "Now you'll be cited if we see one example of noncompliance."

Why the stricter evaluation? The Joint Commission's rationale is that facilities have had more than a decade to create and monitor the effectiveness of their hand hygiene programs.

"While there are various causes for [healthcare-acquired infections], the Joint Commission has determined that failure to perform hand hygiene associated with direct care of patients should no longer be one of them."

We know hand hygiene compliance is a never-ending challenge. Fortunately, your colleagues have come up with plenty of creative strategies to encourage proper hand washing, such as recruiting "spy" staff members who secretly monitor non-compliance, creating music videos and holding art contests. At one hospital, poor hand hygiene could cost a staff member her job.

JoEllen McBride, PhD