67% of Regina-area doctors not properly washing hands
Health region audit focused on improving hand hygiene compliance
We all know that washing our hands is a good way to avoid getting sick, but it appears that message hasn’t gotten through to many doctors and nurses in Saskatchewan.
A February audit shows more than 40 per cent of health-care workers and support staff at hospitals in the Regina area failed to wash their hands properly.
A follow-up report in June also reveals that 67 per cent of 204 doctors observed didn’t follow regional handwashing rules before patient contact.
Regina Qu’Appelle Health Region (RQHR) requires all staff to wash their hands with soapy water or alcohol-based gels for a minimum of 20 seconds before and after contact with patients. They’re not allowed to wear excessive jewellery on their hands or wrists and can’t have gel nails.
Kateri Singer, the woman in charge of infection prevention for RQHR said the region’s goal is 100 per cent compliance with handwashing rules “because it is the single most important thing we can do as health-care workers.”
Poor hand hygiene can be fatal
The director of infection, prevention and control at Toronto’s University Health Network said failure to follow the rules could be fatal for patients.
“In Canada, it’s roughly 8,000 to 12,000 deaths a year directly as a result of health-care associated infections - the majority of which are actually fully preventable,” and he said it’s likely some of those deaths can be attributed to the contaminated hands of health-care workers.
Singer said “we know the repercussions of someone not washing their hands,” but she noted the region’s own research shows that message isn’t getting through to many employees.
RQHR Hand Washing audit results
- Broadview Union Hospital (February) - 94.8%
- Grenfell Health Centre (June) - 77.4%
- Regina Lutheran Home (June) - 77.8%
- Wolseley Memorial Hospital (June) - 66.7%
- Regina General Hospital - Day Surgery (February) - 86.7%
- Regina General Hospital - Labour and Birth (June) - 94%
- Pasqua Hospital - Day Surgery (February) - 100%
- Pasqual Hospital - Short Stay (February) - 95.2%
- Pasqua Hospital - Operating Room (February) - 68%
- Pasqual Hospital - 3A (June) - 97%
Transparency is a key to change
RQHR seems to have taken the lead in Saskatchewan when it comes to transparency regarding handwashing practices. Its public reports are far more comprehensive than any other region in the province.
Singer said transparency can be a catalyst to change behaviour.
“So even with Broadview (Union Hospital) being at 95 per cent non-compliant - that should be an eye-opener to them,” Singer said.
RQHR compliance is improving
There is some statistical evidence this approach may be working. In May 2013 only 34.3 per cent of the regions employees were found to be washing their hands. The most recent survey, in February of this year, found compliance at 59.2 per cent.
In September, RQHR made its handwashing policy mandatory. If employees don’t comply they can be subject to discipline.
And the region is stepping up its auditing approach.
During the February and June inspections, the auditors were quite visible as they moved around the facility observing people and writing notes on a clipboard.
But starting in May, the region began ‘blind audits’ in which observers have been more covert.
“When we see the results of the blind audit we knew people don’t take us serious,” Singer said, noting the compliance rates are even lower when workers think they’re not being watched.
“We hate to trip people up, but it shows us the true story.”
Saskatoon’s compliance appears to be higher
“(Auditors) are standing there. They are visible. It is obvious to the people that are being observed that so there is that human behaviour component that most definitely will be there.”
The most recent audit provided to CBC’s iTeam shows 85 per cent of SHR workers followed the rules; much higher than the 60 per cent compliance rate in RQHR.
Health-care workers resist handwashing
For that reason he said he’s very skeptical of health regions reporting very high compliance rates.
“I believe the ones far more that are reporting the ten percent (compliance). Those ones I believe are actually being open and honest and transparent.”
Right now in Saskatchewan there are no standardized auditing rules for health regions.
Gardam said if the province is serious about improving compliance it should consider adopting provincial guidelines to make it possible to compare regions in a fair and transparent way, which is what Ontario has done.
“That’s the kind of thing that you need to do if really want to improve this. If it’s just simply a matter of window dressing and telling the public ‘Yeah, yeah we’re washing our hands,’ then I guess you can do whatever you want, but I really don’t think that’s going to fundamentally fix the problem.”
The ministry of health said the region's advisory group has considered the idea of provincial standards but has opted instead to share best practices among the regions, which it said will start next year.
How to get health-care workers to wash their hands
In the end, he said, what worked was leadership and transparency.
Hospital management made handwashing a top priority, set hand hygiene targets and then “empowered every part of the hospital to come up with their own way of improving hand hygiene… rather than telling them what to do.”
They brought in electronic systems that monitor hand hygiene 24 hours a day. Every department was regularly audited and those results were posted where staff and patients could see it.
“And for the first time we started to see improvements,” Gardam recalled. “And then we have just built upon this to the point now that for hand hygiene we are well over 90 per cent here.”