COVID-19 has thrown a spotlight on the importance of hygiene and handwashing, yet the latest data audits show doctors are still not meeting benchmarks.
COVID-19 has thrown a spotlight on the importance of hygiene and handwashing, yet the latest data audits show doctors are still not meeting benchmarks.

Audit finds doctors not washing hands properly

Handwashing is the single most important factor in cutting hospital acquired infections - and despite the huge focus on cleaning and sanitising during COVID-19, audits show medical staff are still not always doing the right thing.

Results from 1000 health organisations checked from July to October 31 last year show doctors washed their hands 78.5 per cent of the time - below the benchmark of 80 per cent, with nurses on 90 per cent.

And some of the poorest performers are country hospitals, not their crowded city cousins.

The handwashing results, published by the Australian Commission On Safety And Quality, are better than last year, when the doctor rates were 74.5 per cent and nurses 88.6 per cent, and have been steadily improving in recent years - but are still not universal.

A hand audit in action in an Australian hospital to improve general hygiene and prevent spread of disease. Picture: Jayde Bidner.
A hand audit in action in an Australian hospital to improve general hygiene and prevent spread of disease. Picture: Jayde Bidner.

Health authorities have gradually increased the benchmark to 80 per cent and nationally publish ratings in an effort to get hospitals to lift their game.

Australian research shows targeted campaigns encouraging hand washing have been tremendously successful - for every 10 per cent increase in hand hygiene compliance, there is a 15 per cent drop in S. aureus bloodstream infection in Australia's 132 largest public hospitals.

Gunnedah Hospital in the state's northwest has the worst compliance rate in NSW - with a rate of 69 per cent of hand washing or applying gel last year, according to the latest round of audits published by the Australian Health and Welfare Institute. It's followed by Gosford on 74 per cent and Bathurst on 79 per cent.

By comparison, the best score was Parkes Hospital on 100 per cent. Camden Hospital was the next best, on 97 per cent.

University of NSW infection prevention expert Professor Mary-Louise McLaws, says "hand hygiene is the most cost effective low tech strategy that we have that interrupts the transmission of pathogens from healthcare worker to patient".

Professor Mary Louise McLaws was part of a WHO program trialling hand hygiene and proposes coaching sessions for staff to foster higher compliance. Picture: NCA NewsWire/Gary Ramage
Professor Mary Louise McLaws was part of a WHO program trialling hand hygiene and proposes coaching sessions for staff to foster higher compliance. Picture: NCA NewsWire/Gary Ramage

"However, this strategy is highly reliant on human behaviour of healthcare workers who are busy thinking about many issues at once; thinking about medication, diagnosis and general care related thoughts," she said.

"Staffing levels on wards are tight meaning the nursing staff are usually working at over 100 per cent with little additional time, especially during COVID."

Professor McLaws, who was part of a World Health Organisation program trialling a hand hygiene program around the globe, said her research identified that healthcare worker had developed their hand hygiene habit as children and despite universities trying to retrain them, it had been cemented as a child.

"I have suggested to the Ministry a different approach where a coach comes onto the ward in the mornings every morning and coaches a staff member they see before they make contact with a patient," she said.

Daily coaching sessions would re-cement a new "My 5-moments" for hand hygiene habit that does not require thinking - just action.

"I believe my method is ethical as the current method doesn't demand auditors stop staff inadvertently making contact with a patient before they hand hygiene," she says.

"Voluntary reporting should be replaced with reports on the number and duration of coaching sessions."

Interestingly, in-depth NSW surveys of patients about whether staff washed their hands before they were treated in ED departments show a different set of hospitals performing poorly.

 

 

Some experts believe patient surveys are more accurate, as they rely on genuine patient information, rather than medical professionals knowing they are being observed.

The worst rates, at Royal Prince Alfred, showed patients only saw 50 per cent of nurses cleaning hands before touching them, and 52 per cent at Hornsby.

In those patient observations in emergency departments Kempsey Hospital had the highest number of patients saying they did not see the ED staff wash hands or sanitise before treatment - at 19 per cent.

Next was Goulburn on 18 per cent and then Blacktown, Bankstown and Auburn on 16 per cent.

By comparison, at Deniliquin, the failure rate was just four per cent and the children's hospitals at Westmead and Randwick did well, on six per cent.

 

 

 

Originally published as Audit finds doctors not washing hands properly



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