Nearly one-third of hospital workers are not washing their hands regularly, despite strong evidence that it is one of the primary ways to prevent the spread of infection in hospitals.
A recent report from the Provincial Infection Control Network found that while sanitation-compliance rates have improved since 2007 — when regional health authority programs were set up to tackle hand hygiene issues — the latest statistics show physicians and nurses are still falling well short of the 80-per-cent compliance target.
Good hand hygiene practices can help mitigate the spread of germs like C. difficile, a virulent stomach bug that causes diarrhea and may progress to bowel perforation, sepsis and even death, according to the World Health Organization. The WHO recommends washing with soap and water as the preferred way to deal with C. difficile, which is resistant to hand sanitizer.
The Provincial Infection Control Network documented close to 1,500 cases of C. difficile in B.C. during the past year, with almost half of them in the Fraser Health region.
Lady Minto Hospital on Saltspring Island declared an outbreak earlier this month after four cases were identified, and Royal Columbian Hospital in New Westminster reported 12 infections in April.
The Infection Control Network’s study found that hospital-acquired infections like C. difficile kill 8,000 to 12,000 Canadians a year.
Physicians were among the least likely to wash their hands both before and after contact with patients, according to the report. Nurses, with a 73-per-cent hand-sanitizing compliance rate, were the most likely to do so. Slightly more than half of the physicians observed by auditors made use of basins or alcohol-based handrubs.
“There’s no excuse for not cleaning your hands,” said Dr. Shelley Ross, president of B.C. Medical Association. “There’s probably as many reasons as doctors as to why it doesn’t happen, but we’re planning to send out a little reminder [to physicians] that it’s good practice, and to please remember that the patient’s well-being is at stake.”
The BCMA sends its members an information circular twice a month, Ross said, adding that the hand hygiene reminders will be included in the next issue.
In another attempt to stem the spread of viruses, Provincial Health Officer Dr. Perry Kendall introduced new rules last week that would require health care professionals to get a flu vaccination or wear a mask to stem the spread of influenza.
To monitor hand washing, the Provincial Infection Control Network sends trained auditors across B.C. every quarter to observe a sample of staff in acute care facilities. The compliance rates in the report reflect how often workers wash their hands when the opportunity presents itself. Some of the barriers identified by the study include lack of sinks, availability of hand hygiene products, and people feeling that they are too busy to be washing their hands all the time.
“We know compliance is better if you have hand wash stations close by,” said Kendall. “We’re seeing improvements in newer [hospitals], but older facilities aren’t as well-equipped for it.”
A provincial mandate to tackle the hand-cleaning issue is in place, Kendall said, but implementation is left to the various health authorities and individual facilities.
Initiatives include putting up posters reminding staff to wash their hands, placing alcohol-based sanitizers in strategic areas, and getting patients in the habit of asking caregivers if they have washed up, he explained.
Care facilities in B.C.’s Northern Health Authority, in particular, have been making strides to ensure more hand sanitizers and wash basins are readily available and accessible, said Fraser Bell, the authority’s vice-president of planning and quality.
The Northern Health Authority ranked last among the six B.C. health regions observed by the network last quarter. Auditors noted only 58 per cent of the health-care staff cleaned their hands before and after working with patients.
“It’s most assuredly a number we want to raise,” said Bell. “We’ve put the structures and programs in place to make the improvements. People are seeing the [58 per cent] across the organization and they’re paying attention and beginning to act.”
The Northern Health Authority’s efforts to raise compliance levels is largely in line with what Kendall said other regions are undertaking, said Bell.
Information and education campaigns and in-house auditing run alongside an employee recognition scheme, where the names of fastidiously clean staff are posted on the health authority’s website.
The push for better hand hygiene seems to be moving in the right direction, Bell said, despite last quarter’s dip in the compliance rating.
But Dr. Bonnie Henry, director of the BC Centre for Disease Control, said the study is not definitive. The report’s reliance on audits is a potential weakness, she said, and is one of the reasons why the target performance rate is pegged at 80 per cent and not higher.
Auditors may not be given access in certain situations to collect data and observe, Henry said, such as when staff are in rooms meeting with patients. Nevertheless, she insisted the report’s value as a means to raise awareness cannot be discounted.
“It’s a big-picture indicator that helps us understand what’s going on,” she said. “The report focuses [health authority leadership’s] attention on the issues. It’s very important that authority CEOs look at this and say, we need to do something.”