What’s Up Doc: Why are only half of you complying with hospital hand hygiene rules?

“The critical thing that all of us as healthcare providers can do is clean our hands between patient contact: and that is the number one, two, and three action to keep our patient safe,” said Dr. John Embil, Director of Infection Prevention and Control at Winnipeg’s Health Sciences Centre, in an interview (beginning at the 12:54 mark) at a recent conference on infection control at the HSC.

Patient safety is a live issue because hospital-associated infections (HAIs) are the most common serious complication of hospitalization in Canada, affecting 10% of all patients in acute-care hospitals and are the fourth leading cause of death. And crucially, the contaminated hands of healthcare workers are the most common vehicles of transmission in most settings. In other words, HAIs are preventable.

The solution is literally at our fingertips: just wash your hands. As simple as that seems, the data is telling us that not only is that not happening, it’s also telling us that doctors, of all people – the leaders and role models in the hospital environment – are the biggest offenders.

The hospitals themselves are reporting low hand washing compliance rates of about 65% for nurses and less than 50% for doctors. For example, the Vancouver Island Health Authority reported physician compliance rates as low as 18%.  Yet some people say even those numbers are too high because they are gathered at a time when staff are told they are being monitored. Thus, they argue, the true rate is anywhere between 10 and 30%, with anecdotal evidence suggesting – stunningly – that doctors never wash their hands, outside of surgery.

Physician non-compliance so concerns the medical community that it will be the focus of an upcoming Canadian study that was announced this past February: i.e. why aren’t physicians washing their hands and what can be done about it? In a literature review conduct by the researches in advance of their own investigations they have identified several reasons specific to doctors: namely, physicians reported not ‘remembering to perform hand hygiene;’ ‘high workload or feeling too rushed;’ educational gaps in infection control training among physicians; a perception among physicians that their compliance is much better than it actually is; the development of a more cavalier attitude towards infection control as clinical experience increases, with an associated drop in compliance rates; and the lack of positive role models among physicians who are part of a healthcare team.

Healthcare worker hand hygiene as defined by Dr. Embil above is a hospital Required Organizational Practice, what Accreditation Canada considers an evidence-based best practice that mitigates risk and contributes to improving the quality and safety of health services.

So what’s up doc? If you aren’t getting something  as simple as the hand washing thing right, should patients and their families be asking what else you might not be getting right?

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