Category: Healthcare-Associated Infections

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?

Which Country Leads The World In Infection Surveillance?

The Centers for Disease Control and Prevention (CDC) estimate that healthcare-associated infections cost the United States approximately $45 billion and claim the lives of thousands of patients annually. Surveillance of infections have become an enormous challenge for the healthcare systems across the world, and have become increasingly problematic due to antibiotic resistance. So which country is leading the world in this area?

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Surgical Site Infections In Major Surgeries Can be Reduced

There are a number of studies that have demonstrated conclusively that eliminating a large percentage of the bacteria in the nose of a patient just prior to a major surgery can reduce the number of surgical site infections (SSIs).   The main culprit seems to be Staphylococcus aureus which thrives in the warm, moist undisturbed environment in the nose. Whether it is the highly antibiotic resistant form of S. aureus, MRSA (a known superbug) or the antibiotic susceptible version MSSA, these species of bacteria are responsible for the majority of surgical site infections.

While MSSA is responsible for a greater number of SSIs, MRSA is responsible for the deadly and very costly infections. Some MRSA infections can cost up to $100,000. On average however, SSIs cost anywhere between $11,000 – $35,000, add on average an extra 8 hospital days, and can result in 5 times higher readmission rates. Whichever way one looks at it, SSIs are a huge burden on the medical systems around the world. Some estimates put this cost as much as $10 billion annually in the US alone.

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Hospital TV Remote Controls Carry More Bugs Than Toilet Bowl Handles

A recent study conducted by researchers at the University of Houston concluded that the items in hotel rooms with the highest levels of bacteria are those that are most commonly touched first upon entering a hotel room [1].  Such items include the TV remote, bedside lamp, and light switch. This new evidence coincides with findings from a similar study conducted in 2009 at the University of Arizona, where researchers concluded that TV remote controls in hospital rooms contained more bacteria than items such as the toilet bowl handle and bathroom door [2].

Another important aspect of this study’s findings is the fact that the data suggests that bacteria is most likely to be spread from room to room via the janitorial staff. Items that are transported from room to room, including cleaning carts, mops, and sponges were found to contain the highest amounts of bacterial contamination. After losing my father in 2008 to a number of infections including MRSA and C. diff, one of my biggest complaints was the fact that the janitorial staff at the hospital would clean the entire ICU with one bucket and mop, never stopping to change the cleaning solution from room to room. Because C. diff can form spores that are able survive on surfaces for long periods of time, such cleaning mechanisms are essentially causing more harm than good by transporting bacteria from room to room. While this present study focuses on hotel rooms, it still raises the issue of inadvertently transporting bacteria across hospital rooms.

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Clostridium Difficile Outbreak Kills More than 30 in Ontario

Finally, it now seems that the Ontario hospitals affected by clostridium difficile have gotten the outbreak under control.  Hospitals, especially within the Niagara region, noticed a surge in C. difficile cases since May of this year and many struggled to keep the number of serious infections and resulting deaths down.

C. difficile is a superbug that can secrete high levels of toxin.  It causes symptoms of severe diarrhea and swelling of the colon, which can burst and result in death from septic shock.  C. difficile infections mainly result from eradication of the normal gut flora by antibiotics, and often affect the elderly, patients with weakened immune systems, and patients who have had previous surgery. In many cases, C. difficile spreads in hospitals through contact with fecal matter and can stay hidden in a body without showing symptoms for long periods of time.  Once infected with this superbug, patients are forced to suffer from severe dehydration, diarrhea, organ failure, and blood poisoning. Read More

A Trip to the Hospital Turns into a Lesson in MRSA

Walking into the hospital is always daunting because it’s confusing and not a place people visit under normal circumstances.  So when I went to St. Paul’s last week after my grandpa had open heart surgery I tried to be prepared.  I looked up maps so I wouldn’t get lost meeting my sister in the hospital and set off with my “Get Well Soon” balloon in tow.  The one thing I wasn’t prepared for was the ensuing reality check.

As we began our trek to the cardiac unit, my sister insisted we stop at every hand washing station.  No, she doesn’t have obsessive compulsive disorder; she works in a hospital so she knows the importance of maintaining proper hygiene.

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The 5 Minute Simulator that Could Save Your Life

The US Department of Health and Human Services has created an interactive training video simulation that lets you participate in life-changing infection control decisions. In a program called Partnering To Heal:Teaming Up Against Healthcare-Associated Infections, the video educates viewers on how to prevent some of the most serious healthcare-associated infections (HAIs), such as surgical site infections, from occurring in hospitals.

There are five character options in the simulation-a doctor, a nurse, an infection preventionist, a family member or a third-year medical student. You are completely in control of each person and every decision that you make will change the patient’s life forever.  The dramatic and sometimes shocking outcomes allow you to peel back the curtain of medical care to better grasp the impact of your decisions and how they can affect your patient’s health.

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