Not enough doctors washing their
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
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
The CHUM has already carried out hand-hygiene audits in problem areas,
but plans to expand them to all areas of care, Dufresne said.