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Patient safety

Not enough doctors washing their hands: study

MONTREAL - An internal audit at the McGill University Health Centre found that only one in four doctors (25%) wash their hands between patient visits. Nurses do a better job, but their rate of compliance is still only 40 to 50 percent. Lack of handwashing has been identified as a major factor in the spread of germs in hospital settings.

Results from the audit, which was conducted in 2008, show little progress has been made since a study was conducted at the MUHC in 2001. That study found that fewer than one in four doctors and less than 40 per cent of nurses took hand-hygiene precautions - such as using hand sanitizers.

Charles Frenette, medical director of infection control at the MUHC, told the Montreal Gazette newspaper that his department has had a difficult time persuading health professionals to take handwashing seriously. “It’s something that’s hard to change,” he said. “It’s like stopping smoking. It takes a lot of time. It’s a long-term process and we’re just beginning to have the tools with those audits to try and change people’s behaviour.”

Research has shown that 30 percent of hospital-acquired infections can be prevented through handwashing.

The MUHC, like other health centres across the country, has been hard hit with outbreaks of multi-drug-resistant bacteria. In 2003-2004, 780 patients at the MUHC contracted the C. difficile bacterium, 84 per cent of whom caught the infection in its hospitals. Of those patients, 36 died from C. difficile-related complications and another dozen required emergency colorectal surgery.

Accreditation Canada, the national council that certifies hospitals, is so concerned about the lack of routine handwashing by health professionals that it set tough new standards as of Jan. 1.

Previously, hospitals were simply required to provide proof of educating staff and volunteers about the importance of handwashing. But now, they must carry out audits of hand-hygiene practices, share those results with staff and volunteers, and show measurable progress.

Hospitals that fail to improve within a couple of years will receive poor ratings by the council, and in the worst of cases, could risk losing their accreditation. The standards also apply to nursing homes and other health-care facilities.

“Everyone would agree that handwashing is a no-brainer, but you and I both know that people do not wash their hands with the frequency required or do it properly,” said Wendy Nicklin, CEO of Accreditation Canada. “Whether it’s the SARS outbreak in Ontario (in 2003) or the C. diff problem in Quebec, there’s been a dramatic increasing awareness and concern for the need for healthcare professionals to take increasing diligent steps” with hand hygiene.

The MUHC has installed alcohol-based hand-rinse dispensers throughout its hospitals. Staff and volunteers are required to wash their hands before and after every patient.

In addition, people visiting patients who have been infected or colonized by a drug-resistant bacterium must wash their hands as well as wear a mask and gloves.

The MUHC’s internal audit found that hand-hygiene compliance was only 50 percent in the intensive-care wards. Full compliance is thought to be impossible, but some hospitals around the world have succeeded in reaching 70 percent rates.

At the Centre hospitalier de l’université de Montréal, the infection-control team is planning an awareness campaign to educate staff at the end of this month.

Our team will visit each of our three hospitals, in each of the departments and at the start of each of the shifts,” CHUM spokesperson Lucie Dufresne said. Staff will be asked to wash their hands and then the inspectors will shine an infrared light on them to reveal any missed spots.

The CHUM has already carried out hand-hygiene audits in problem areas, but plans to expand them to all areas of care, Dufresne said.