News  Medical staff don’t wash hands, audit shows

Lack of cleanliness has contributed to bacterial outbreaks in some McGill hospitals

As few as one in four doctors at some McGill-affiliated hospitals wash their hands between patients, according to a hospital audit conducted by the Montreal Gazette and published on January 6.

This rate is not unusual, according to Dr. Laurie Taylor, the Director of Operations of the Canadian Patient Safety Institute. Nurses fare only slightly better, according to the audit, scoring an overall rate of around 40-50 per cent.

The issue of sufficient hand washing in health professions hits home due to C. difficile, a potentially fatal bacteria that can cause fever and diarrhea. Canada has taken heavy hits from C. difficile; it spread like wildfire through Quebec hospitals and nursing homes in 2003 and 2004, and was responsible for nearly 2,000 deaths.

According to Wendy Nicklin, President and CEO of Accreditation Canada – a national, non-profit, independent organization that helps develop health safety standards – C. difficile has become a bigger problem during the past decade.

“There’s been an increased focus on infection,” noted Nicklin. “We’ve seen an increase in C. difficile and MRSA [another dangerous bacteria that often spreads in hospitals], and because of this, experts in infection prevention and control are trying to understand why. Hand washing has become an area of focus [for] health care organizations to improve their rates.”

A McGill University Health Centre (MUHC) employee, who wished to remain anonymous, was unfamiliar with the source of the data but offered the opinion that the variation in rates of hand washing are due to differences between high stress and low stress areas in the hospital.

“When you have [doctors] running around in the emergency department, these people are working very hard,” the health employee said. “Washing hands 100 per cent of the time is virtually impossible. In some areas, it’s easier than others.”

However, emergency environments such as MUHC’s intensive care units were the areas of the hospital in which 60 per cent of doctors – the highest of any area in the hospital – washed their hands in between seeing patients.

Taylor warned that varying institutions’ statistics can mean different things.

“[It depends] on how the data was collected – you have to be careful about comparing data between different organizations,” she said. “You have to be careful about how many observations there were and what time of the day and night they were being [collected].”

Nicklin noted that any organization with hand washing rates similar to MUHC could be prone to infection problems – though MUHC’s rate of handwashing is average.

“I would say in any health-care organization [infections could take hold]. I’m not sure the MUHC is any different from other health centres. I’m not sure that I would single out the MUHC,” Nicklin said.

Taylor suggested that patients should help themselves by keeping an eye on their doctors.

“You can be your own advocate when it comes to hand hygiene,” she said. “There is nothing wrong with asking your provider if they have washed their hands before they examine you.”