Health Professionals Oblivious to Hygiene?

"We are still under the illusion, based on the hand-hygiene rates that are measured and reported across the province that we are all high performers."
"But this is simply not the case."
Dr. Jerome Leis, Sunnybrook Health Sciences Centre

"These things [germs] don’t fly through the air – with very, very few exceptions. They get around on a vehicle, and that vehicle most often is our hands."
"Very few people would ever be comfortable asking their health-care providers if they’ve cleaned their hands. Our patients feel very vulnerable. They are in an imbalanced power relationship with us, so it is really hard for them to ask."
"We have made great increases in our hand-hygiene compliance, and the most recent results show our overall rate is now 87 per cent."
"We know from recent surveys of our patients that they know health care providers should clean their hands and they expect it of us, even though they are reluctant to ask."
Dr. Mary Vearncombe, Medical Director of Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto

"In the past decade, a lot has evolved and focusing on patient engagement has begun to dramatically change the health-care landscape."
"Patients are a huge additional resource to help with this issue [to enquire of health staff whether they've washed hands]. We just have to find the best way to engage with them."
"Anecdotally, I have heard about other hospitals [besides Sunnybrook which initiated a pilot project where staff wore buttons reading: Ask me if I cleaned my hands] that have tried this way of empowering patients and found that the buttons served as a launching pad for a discussion. Patients felt that the buttons gave them a segue into a conversation." 
Sudha Kutty, director, Quality Improvement Strategies and Adoption, provincial government agency Health Quality Ontario

Sunnybrook Health Sciences Centre website

Given the vital necessity that health professionals ensure that they don't carry pathogens from one infected patient to another, thus complicating the health status of vulnerable patients in a hospital setting, one supposes that patients should take the initiative to ask nurses and doctors attendant on them whether they have, in fact, cleansed their hands of possible germs in passing from one patient to another. Much depends on it.

Hospital outbreaks of Clostridium difficile infection (c. difficile) are notoriously difficult to expunge from a hospital setting once established, and that establishment of a widely-infectious hospital outbreak is a direct threat to the health status of patients recovering from surgeries or those with compromised immune systems as a result of dire chronic diseases taking their toll.

Busy nurses and doctors can be reminded incessantly of the real and required virtues of hand-washing as a personal responsibility, but if the mindset hasn't been firmly established it will migrate away to the back of the mind and languish there. At Sunnybrook Hospital, Dr. Leis and his colleagues assigned two medical students whom they had given training to, as surreptitious hand hygiene inspectors, to monitor the prevalence of hand-washing at the hospital.

Their covert surveillance revealed that compliance to the mandatory hand-washing was in the 50 percentage range, whereas the officially accepted rate was 84 percent. Even the 'official' rate, shown to be incorrect, leaves ample room for infections to multiply; 50% represents a shameful scandal that those in the healing professions cannot take their responsibility seriously enough to wash the potential germs from a patient they've attended, before going on to another patient.

In fact, Ontario law requires that hand-washing be routinely done in hospitals, a requirement that was established in 2008, that also requires hospital record rates, to be reported back to the provincial health ministry. The percentage of compliance that Dr. Vearncome so confidently reported above, was proven to be incorrect, as the new study out of Sunnybrook hospital revealed. That study released evidence that hygiene rates taken for granted are overly optimistic.

The medical students engaged to secretly monitor hand-cleaning discovered that only half of staff nurses and doctors bothered to wash their hands between patients and that is a number far below the official rate. With the results now made public, Toronto area hospitals are rolling out new plans to measure compliance with hygiene rules electronically in hopes of preventing deadly problems of hospital-spread infection escalating from their current troubling reality.

The possibility that an automated system will prove to have greater accuracy than the data acquired by human "auditors" used countrywide may provide a solution. And a solution is certainly required given the current data, that infections which patients contract after hospital admission are estimated to cause 8,000 deaths in Canada on an annual basis. And the culprit is the unwashed, contaminated hands that are meant to heal, not deliver pathogens compromising patient safety.

All the hand-washing campaigns that have been undertaken in years past by hospitals, provincial health ministries and conscientious health workers attempting to persuade others to become more responsible don't appear to have worked as well as might have been expected, with doctors and nurses failing to scrub as often as they should. There are provinces reporting rates of compliance up to 91 percent, and that appears to be mostly wishful thinking.

The kind of wishful thinking that health experts have suspected have been vastly over-rated. A 2014 Toronto University Health Network using electronic surveillance, hoping to eliminate the phenomenon, discovered that hand-washing rates were on the level of reality a good deal lower when no human auditor stood nearby to view what was happening.

What the study also revealed was another astonishing realization: that when the supervising physicians themselves overlooked the need to personally wash, medical residents' rate of handwashing plummeted from 80 percent to 19 percent.