Tuesday, March 06, 2007

I can't paper over this story any longer

Back on January 15 I posted a piece about our misadventures with new paper towel dispensers.

Hundreds of you have demanded an update on this dramatic story. Here it is, in the form of an email from our manager of environmental services. We are all pleased that the problems have been solved. But, please Mark, did you have to call it a "roll-out"?

On March 5, 2007, we will expand to the East Campus our program to replace mechanical paper towel dispensers with battery-powered, "hands free" dispensers. These new dispensers reduce the chance of cross contamination and thus facilitate improved infection control.

As you know, we faced problems with the initial roll-out on the West. These were mainly related to the specific kind of paper towel we started to use. We have switched to a paper towel comparable in quality to the one we had always used. These new paper towels have been in place with the new dispenser for six weeks on the West and have been considered appropriate and acceptable.

We are now moving forward to replace dispensers on the East Campus and will be starting with replacing those that currently use a "hand lever". This should take about one week (i.e., 3/5-3/9).


Anonymous said...

This is very funny to me, because I used to work in a hospital with similar paper towel issues. I was a pathologist and we used millions of paper towels, one at a time from an open stack, to examine our fresh specimens from the operating room (not to be gross, but they were very messy) and perform other tasks. For some reason, the towels were always in short supply so every dept. in the hospital started hoarding them in locked cabinets, trading and bargaining with them, etc. Then, the hospital swtiched to a different brand which was cheaper. The only problem was, they stuck together in a stack, so that when I plucked one from the stack to examine my specimen, I would get about 30 instead, 29 of which were not needed, but were now bloody and contaminated and so had to be tossed. Who knows how they affected other departments.

It was always a source of cynical humor for us that, in trying to save money but not asking anyone first, the hospital probably lost more money.

Anonymous said...

What about installing those super-duper new air driers? Unlike the old air driers that take forever to dry your hands, these new ones only take about 10 seconds, and you don't feel like your hands are still damp afterwards. And no paper towels at all.

Anonymous said...

But my question is will you be removing the old dispensers? The hospital I work in currently serves as a mini- museum of paper towel dispensers. New ones are added, but old ones rarely taken down. No idea why. Drives the house keepers nuts, and causes the rest of us to wonder how much each dispenser cost.

Bill said...

Dare I ask if the bathroom doors swing outward?

It is always annoying to have to do the whole "Dry hands, open door with paper towel, hold door open with foot, lean over and toss paper towel into trash can" dance when my shoulder would be more than pleased to open the door in lieu of my hands.

Anonymous said...

I second Bill's comment about doors that don't swing outwards.

If doors don't swing outwards, maybe you can install those instant hand sanitizers in plain view upon exiting the restroom. Or move the trash can closer to the door? Or just get second, but smaller trash cans to put by the door. Or if trash cans cannot be placed near the door because of space constraints, get wider trash cans so people who toss paper towels across the room can make it into the trash can.

While I'm at it--other (I admit, obsessive) restroom ideas: don't touch the locks on the stalls. Use toilet paper to lock and unlock. Use foot to flush toilet. If doors swing outwards, use foot to push it open. For doors that swing inwards: if there's someone else who's washing their hands, discreetly wait until they're done so you can open the door for them (or vice versa, wait for them to open the door for you, follow them out by holding the door with your foot if they didn't realize you were behind them) so that only one of you will have to touch the door handle. If you must that the door handle, open it with a single finger.

Anonymous said...

OK - I'll bite (We'll see if I still have a job tomorrow... :-)

I respectfully disagree... My experience in the ER is that even with the better paper towels, this is a huge disincentive to hand washing.

1) The machine gives a certain amount of paper towel (12" or so) and then locks you out for 10-20 seconds. It takes 2-3 dispenses to fully dry your hands. Putting on gloves if your hands aren't completely dry is very unpleasant and will literally rub off your skin-- try it sometime!

2) The machines seem to jam a LOT. It's not uncommon that one has to go from room to room to room to find one that's working.

I like the idea of trying to save money and decrease natural resource utilization (for years my wife and I stored our recycling in the garage and drove it to the depot ourselves).

But I think a different solution is needed for patient care areas, particularly the ER. Having nurses and doctors standing idle at the sink waiting to be given another paper towel is not good use of precious staff time in an area where seconds do count.

If nothing else, how about decreasing the lockout period?


Anonymous said...

I can advise that we will not become a "paper towel dispenser mini musuem" as we are trading the dispensers out one for one!

Anonymous said...

Mr. Levy,

Why do we have the electric hand dryers and then have to use our hands (as opposed to opening the door with a paper towel). I see many who do not wash their hands, so therefore the germs are passed via the door handle. My suggestion is to put a handicapp door opener or switch to paper towels in the restrooms that currently have electric hand dryers.

Anonymous said...

Are you Monkish? Give me a wipe Natalie!!!

Anonymous said...

As the manager of Environmental Services at BIDMC (and thus the one who “owns” the paper towel decisions and process), I wanted to respond to several of the comments/replies that have been offered.

Our announcement that we will continue with paper towel dispenser installations (and the quite unintentional play on the word “roll-out”) inspired Mr. Levy's levity (sorry) in his Blog comments. All in good fun. But along with the fun came good questions and constructive suggestions that I’m pleased to have the opportunity to address.

Beyond the jokes, paper towels are just one of many issues in a hospital that may seem trivial but are so important for helping our clinicians do the very best job they can and helping our patients stay safe.

anonymous said.... "What about installing those super duper new air driers..." As many opinions as there are about paper towels is only exceeded by the diversity in opinions about hand driers. We do have them in some of our busier restrooms in public areas that are predominantly used by patients and visitors. It clearly facilitates keeping these busy restrooms neater. In general, our clinical staff have not wanted us to put them in the clinical areas given some people’s need for paper towels for other purposes.

There was also a suggestion about where the trash receptacles should be placed (i.e.,close to the exits ) and to have all bathroom doors swing out. We’ll review this to see where it would work without causing other fire safety/egress issues. We’ve learned: let’s not solve one problem and cause another!

Finally, a physician in our emergency department noted some technical problems that made the automatic dispenser a bad alternative. We did have some problems with some of the early dispensers that we put up but thought we had replaced or repaired those and had received positive comments more recently. But it’s quite possible that we hadn’t gotten every problem dispenser. So I personally visited the ER that afternoon and used at least 25 paper towel dispensers wherever I could gain entrance to open rooms and restrooms throughout.

It is true the machine will dispense 12-14" of product and then stop and reset. The idea is to dispense a certain quantity and try to save the "free wheeling" use of a roll towel. There is a red light that flashes within 2 seconds of dispensing, indicating that the machine is ready to dispense again. If a user keeps their hands constantly in front of the machine, it can keep the machine from re-setting. But just in the time it takes to rip off the first set that has been dispensed (and certainly once those are used), the equipment has reset. I personally tested out on dozens of machines and it worked.

I never knew that I would become an expert in the inner workings of the paper towel dispensing system, but that’s the life of a support services manager in a hospital. And why I love it.

The fact that Paul Levy recognizes how important services like the one I run is to a hospital and patient care is why I love working at this hospital!