Novant Health, one of the top 10 integrated health systems in the US, dramatically increased hand-washing compliance from 49% to 99% and decreased MRSA infection rates by 53% from 2005 to mid-year 2008 by implementing a hard-hitting, system-wide campaign that changed the health system's culture and spared an estimated 249 patients from the medical complications of MRSA.

Executives at Novant Health feel so strongly about hand hygiene and improving the quality and safety of patient care, they are making the health system's educational materials and details of their preventive programme available and downloadable free of charge.

"Any health system can accomplish what we did," challenges Paul Wiles, Novant Health CEO, whose team embarked on the no-holds-barred, zero-tolerance campaign after he was devastated by the death of a premature infant from MRSA and a MRSA outbreak in a Novant hospital neonatal unit.

Paul learned that the spread of MRSA to 18 premature infants was a direct result of hospital staff and physicians not properly washing their hands before, in-between, or after caring for these infants. Two infants died from complications related to being born prematurely and to MRSA.

"What an enormous cost to pay for neglecting the very simplest of precautionary measures of infection control," he says. "The true cost had been in human life, but also there was the significant loss of honour and pride among clinical staff who personally accepted their failure amid careers they devoted to saving lives instead of taking them. After reading a report about this case, I realised my role as CEO must be creating a culture of hand hygiene and infection control because nobody else but me could make that happen."

The campaign - which includes hiring hand hygiene monitors to roam hospital halls and educate doctors and nurses who don't properly wash their hands, together with billboards, screensavers and tough posters such as one that shows a child in a hospital bed and warns, "You Could Kill Him With Your Bare Hands" - is in its third year, despite early discomfort by some hospital staff and the risks involved in such directness.

Novant had always used the traditional resources for hand hygiene education that many hospitals in the US use today, but it was obviously not enough because it never changed behaviour, according to Jim Tobalski, senior vice president of marketing & communications at Novant Health. He was charged with spearheading the employee educational campaign and helping the clinical team improve hand hygiene compliance. He admits that he initially had no idea how to accomplish the goal.

"The project was huge, but I knew to be successful, we had to scrap what I refer to as the traditional 'Mr. Scrubby Bubbles' approach and do something totally different," he explains.

Novant's two-year results come at a time when a new survey by the Association for Professionals in Infection Control and Epidemiology shows most infection-prevention professionals don't believe hospitals are doing enough to ensure proper hand hygiene. In addition, the Centers for Disease Control recently updated estimates of healthcare-associated infections to 1.7 million infections and 99,000 associated deaths in US hospitals each year.

"When we began our campaign, it was estimated that only 40% - 50% of hospital workers nationwide washed their hands properly," reveals Paul Wiles. "That's unacceptable. We must all create a culture that prioritises proper hand hygiene and infection control, makes people accountable and accepts nothing less."