Visitor restrictions are commonly announced at health-care facilities to curb outbreaks of respiratory or gastrointestinal illness.
It’s a problem across the country, with concerns heightened further in some regions over hospital-acquired bacterial infections, such as methicillin resistant staphylococcus aureus and clostridium difficile.
In addition to educating the public, health authorities have recently been reassessing hygiene practices among their staff.
Eastern Health, the largest health authority in Newfoundland and Labrador, conducted a hand hygiene compliance audit from April to June this year, involving 5,576 employees in its long-term and acute-care facilities. The results are expected to be available this fall.
The audit followed an awareness campaign, launched in March 2010, to encourage proper hand hygiene practices among health-care workers in direct contact with patients.
The health authority distributed posters and handouts, conducted hand hygiene readiness audits for staff and installed more alcohol-based hand rub and hand washing stations throughout its facilities.
A similar campaign was credited with improving hand hygiene among employees of the Capital District Health Authority in Halifax, from 44 per cent compliance to 70 per cent. That’s still 30 per cent non-compliance.
St. John’s lawyer Ches Crosbie devoted a recent blog on his website (www.chescrosbie.com) to the topic, saying he can “only imagine that our performance here in Newfoundland is as bad as, or worse, than in Nova Scotia and in Ontario, where it has been less than 40 per cent.”
Merlee Steele-Rodway, Eastern Health’s regional director responsible for medical device reprocessing and infection prevention and control, said Eastern Health is working to ensure that its hand hygiene compliance is at an acceptable rate. She said proper hand hygiene is a big part of providing safe, quality care.
Steele-Rodway said this is the first audit of its kind at Eastern Health.
She said success will also depend on education, routine observations and feedback.
“We’re no doubt going to have to repeat our audit. That’s not something new,” she said.
Health authorities in Ontario and British Columbia have been doing constant observations and reporting to staff on how well they’re doing.
Proper hand hygiene is also an Accreditation Canada requirement. While 100 per cent compliance would be ideal, Steele-Rodway said few centres meet that goal. Eastern Health is hoping to see at least 80 per cent.
The Halifax health authority outlines its infection prevention and control mission on its website (www.cdha.nshealth.ca), advising patients to wash their hands during their hospital stay, asking visitors to do the same and urging patients to “not be afraid to ask those providing you care to wash their hands or wear gloves.”
The Capital District Health Authority references a 2003 study that estimated that 250,000 people in Canada, or one in nine patients, who are admitted to hospital every year get infections while being treated for something else.
Eastern Health maintains hand hygiene is the single-most important strategy to prevent the transmission of germs, particularly after contact with blood, bodily fluids, secretions, equipment and potentially contaminated surfaces.
Its hand hygiene policy applies to “employees, agents and visitors.” Hand washing can be done using soap and water or an alcohol-based hand rub containing a minimum of 70 per cent alcohol, when hands are not visibly soiled. If hands are visibly soiled, washing with soap and water is recommended.
Steele-Rodway said health professionals working with patients should keep their fingernails short and clean because long nails can harbour bacteria and puncture protective gloves.
Staff who care for patients aren’t permitted to wear artificial nails and nail enhancements, as they can also harbour germs. Jewelry that can hinder hand hygiene is also forbidden for staff who have contact with patients. Eastern Health says rings can increase the number of germs present on hands and increase the risk of tears in gloves.
These policies were reinforced last year in a “Dare to bare — below the elbows” campaign.
Steele-Rodway said while some people worry their skin might become irritated from repeated hand washing, Eastern Health recommends people dry their hands well and then applying a hospital-approved hand lotion.