It would be funny if it weren’t so scary—and more than a little sad. At North Shore University Hospital on Long Island, reports the New York Times, sensors and cameras are being used to monitor staff hand-washing. And don’t even think about just waving your hands under the water, mister: The guy in India at the other end of that camera can tell if you’re skipping the soap. And he’s taking notes.

We’ve all seen the statistics on healthcare-associated infections (HAIs), superbugs, and the importance of simple hand-washing to avoid the spread of infection to patients whose conditions render them especially vulnerable. And still, this simple step isn’t always being taken. Now, with Medicare reimbursements threatened by proof of preventable infections within hospitals, facilities are getting more aggressive.

“Studies have shown that without encouragement, hospital workers wash their hands as little as 30 percent of the time that they interact with patients,” writes Anemona Hartocollis in the Times article. “So in addition to the video snooping, hospitals across the country are training hand-washing coaches, handing out rewards like free pizza and coffee coupons, and admonishing with ‘red cards.’ They are using radio-frequency ID chips that note when a doctor has passed by a sink, and undercover monitors, who blend in with the other white coats, to watch whether their colleagues are washing their hands for the requisite 15 seconds, as long as it takes to sing the ‘Happy Birthday’ song.”

Dr. Bruce Farber, chief of infectious disease at North Shore, told Hartocollis: “This is not a quick fix; this is a war.” North Shore did a 16-week study in which worker hand-washing rates rose from 10 percent to 88 percent once those workers started getting reports (based on the filmed findings) emailed to them and displayed on electronic scoreboards. Looks like a little shaming goes a long way.

But then again, here’s the funny/sad part: Elaine Larson, a professor in Columbia University’s school of nursing who’s studied hand-washing much of her career, notes in the article that electronic monitoring efforts (like those used at North Shore) still aren’t perfect. “People learn to game the system,” she said. “There was one system where the monitoring was waist high, and they learned to crawl under that. … It’s just amazing.”

I’ve written about how designers can play a role in controlling HAIs through material choices and locating sinks and sanitizer dispensers in easily accessible, convenient locations. But this article reminded me of a design-driven “incentive” that adds another layer of peer pressure in fighting Dr. Farber’s war: Positioning sink faucets and sanitizer stations in the direct eye line of patients and their families. The general public is becoming more and more aware of the danger of HAIs and hand-washing’s role in preventing them; hospitals, too, are encouraging patients to pay attention and speak up. You know how some coffee shops or restaurant chains will tell you, “If we don’t give you a receipt, your meal is free”? Maybe we should do that for patients: “If you don’t see me wash my hands, your liver transplant is on the house!”