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Doctors, nurses and other health-care workers at Canada's largest research hospital will soon learn that cleanliness is not only next to godliness - it also brings them that much closer to a Timbit.

In an effort to persuade hospital workers to properly clean their hands, a roaming posse of infection control staff at University Health Network will give a $2 Tim Hortons gift certificate to some of those caught cleaning their hands at its Princess Margaret, Toronto General and Toronto Western hospitals.

The gesture, to begin later this month, is aimed at reducing the number of hospital-acquired methicillen-resistant Staphylococcus aureus (MRSA) infections to zero, said Michael Gardam, the director of infection prevention and control for the University Health Network.

"We're looking for a definite decrease in nosocomial [hospital-acquired] MRSA as that is primarily affected by hand hygiene," said Dr. Gardam. "If all of our systems work appropriately, we theoretically should be able to get our hospital-acquired rate to zero."

Hand hygiene is a crucial and obvious step to reducing infections, yet prodding those who provide care to scrub up has been maddeningly difficult: Only 40 per cent of Canadian health-care workers wash their hands properly.

Over the years, hospitals, keen to increase that figure, have installed alcohol hand rubs in hospital corridors and next to patient beds. Button and poster campaigns encouraging people to scrub up are dreamed up by those working in infection control.

Still, an estimated 220,000 patients suffer from hospital-acquired infections each year, according to the Canadian Nosocomial Infection Surveillance Program. Another study by that same group found one of 10 patients admitted to hospital leaves with an infection.

Chantal Backman, the Canadian Patient Safety Institute's interim director of operations for Quebec, Eastern Canada and Nunavut, described hand hygiene as a simple measure that can halve the number of hospital-acquired infections, of which MRSA is one type.

"Hand hygiene does reduce health-care-associated infections and does save lives," Ms. Backman said yesterday. "One of the big challenges is how do we refresh that message? One of the ways as UHN [University Health Network] is currently promoting, is really providing an incentive, in a novel way, to increase hand washing."

University Health Network's Dr. Gardam said he got the idea after hearing how Cedars-Sinai Medical Center in Los Angeles offered $10 (U.S.) Starbucks gift certificates to doctors in a bid to increase hand hygiene compliance.

Though the coffee chain is different, and the gift certificate's denomination is more humble, the thought is the same: a small token to reward those with "good behaviour as well as try to improve the not so good," said Dr. Gardam. To that end, he has purchased $1,000 worth of Tim Hortons gift certificates and will buy more should he receive a favourable response from hospital workers.

As the head of infection control, Dr. Gardam is eager to ratchet down the number of infected patients.

Three years ago, for every two patients infected or colonized with MRSA who were admitted to one of the network's three hospitals, three additional patients would have ultimately acquired the superbug. That figure has improved so that two patients admitted with MRSA now result in one additional case.

Dr. Gardam wants to get that number down to zero, something he said, that can be accomplished by improved hand hygiene, the wearing of gowns, gloves and masks when treating those with MRSA and decolonizing those with the superbug through special antiseptic baths and nasal ointment. (Colonization means the organism is present on the body but is not causing illness in the person.)

Yesterday, Dick Zoutman, physician director of the Community and Hospital Infection Control Association of Canada, said he thought the gift certificates would help reinforce the message that hand washing is vital to reducing hospital-acquired infections.

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The science of handwashing

Unfortunately, it isn't good enough just to wash your hands often. You also have to wash your hands the right way.

1. Use a paper towel because germs can live in wet hand towels. If you have to touch a container or a knob to get the towel out, do it before you wash your hands, then hold it under your arm until you need it.

2. Wethands with warm water.

3. Soap up. It's better to use a liquid soap because germs can live on wet bars of soap. Bar soap is acceptable as long as you dry it on a rack.

4. Rub your hands together for 10 to 15 seconds. Wash longer if you can still see dirt on your hands. Make sure that you wash in between your fingers, the backs of your hands, your thumbs, and under your fingernails.

5. Rinse your hands thoroughly with warm water. Make sure that you rinse in between your fingers and under rings.

6. Pat hands dry. If using a blow dryer, push the button with your elbow.

7. Use the towel to turn off the water. If you touch the water faucet after you wash your hands, you may get germs on your fingers again.

SOURCE: UNIVERSITY HEALTH NETWORK