H
Hydrogen
Guest
Years ago my mother almost died from a hospital-acquired infection. Back then most people thought it an extremely rare event. Now 220,000 people develop such infections each year - and a surprising portion is due to people not knowing basic hygiene, like hand washing.
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Hospitals face hand-washing crackdown
Amid growing concern over spread of infection, watchdog demands hygiene audits and compliance plans from acute-care facilities
LISA PRIEST
From Tuesday's Globe and Mail
May 20, 2008 at 2:00 AM EDT
Canadian hospitals seeking accreditation will soon be required to audit whether their doctors and nurses are washing their hands – and are expected to do something about it if they are not.
Beginning next January, Accreditation Canada will compel virtually all acute-care hospitals – in addition to those nursing homes and other facilities seeking stamps of approval – to not only do hand-hygiene audits but to have a plan to maintain or improve hand-washing compliance.
Not even hospital volunteers will be exempt: They and hospital staff will be trained on how to properly wash their hands and to know when it is required.
“Clearly, hand hygiene is a very important step in the prevention and/or control of spread of infection,†said Wendy Nicklin, president and chief executive officer of Accreditation Canada, formerly known as the Canadian Council on Health Services Accreditation, a non-profit, independent organization. “ …We're at the point where we can't afford not to do it.â€
No wonder: With only 40 per cent of health-care providers in Canada properly washing their hands, experts say, infection prevention has become a hot-button issue.
An estimated 220,000 people develop hospital-acquired infections in Canada each year; at least 8,000 patients are killed by them, roughly the same number as those who die from car accidents and breast cancer combined. And yet, half of all infections could be prevented through proper hand hygiene, experts say.
Although accreditation is a voluntary process, 99 per cent of Canada's acute-care hospitals participate in it, as do many nursing homes, some community health centres, home-care organizations and other health-care facilities. Accreditation Canada accredits 3,515 sites of 995 organizations.
By compelling hospitals and other health-care facilities to do hand-hygiene audits, the organization is following the lead of other countries. In the United States, hospitals not only face similar audits, but health-care providers are required to cleanse their hands 90 per cent of the time when it is warranted, such as before and after seeing a patient.
“It's high,†said Louise Kuhny, senior associate director of the standards interpretation group of the Joint Commission, a non-profit organization that accredits and certifies U.S. health-care organizations, of the 90-per-cent hand-hygiene compliance rate. “And it's a big requirement but we feel that it's important because clearly infections are directly related to this.â€
Michael Gardam, director of infection prevention and control for Toronto's University Health Network, said most hospitals do not have the resources to do the labour-intensive auditing – something that will likely change with the new requirement.
Typically, auditing involves dispatching a roaming posse of hand-hygiene workers with clipboards to discreetly observe whether health-care providers are washing up.
“By making it mandatory, they will need the resources to be able to do the audits, which in my mind is really important,†said Dr. Gardam, who heads MRSA intervention for Safer Healthcare Now!, a national group that helps implement safer health-care practices in hospitals.
The problem of poor hand hygiene has confounded some of the best scientific minds in search of a solution. There have been poster campaigns and buttons. Hospitals have even doled out Tim Hortons coupons as a reward to health-care workers who scrub up. Some of the problem has been attributed to a perception deficit: Many health-care workers think they are already doing a good job of washing their hands.
In an effort to prevent infections, some hospitals have even instituted bans. At Sunnybrook Health Sciences Centre in Toronto, artificial fingernails, long natural nails and rings with stones are forbidden; no staff member providing direct patient care can wear them.
Bracelets that dangle past the wrist near the hand are another no-no, save for religious reasons. Even in those cases, the bracelets must be pushed up on the arms and kept in place. Plain wedding bands are discouraged but not banned.
Mary Vearncombe, Sunnybrook's medical director of infection prevention and control, said the bans are based on scientific evidence. Artificial nails, for example, trap moisture and can harbour yeast and gram-negative bacteria such as Pseudomonas aeruginosa.
“There have been some patients who have died, babies who have died [in North America], traced back to artificial nails,†said Dr. Vearncombe, who is also chairwoman of the provincial infectious diseases advisory committee's subcommittee on infection prevention and control in Ontario.
If the last audit, done in March, is any indication, Sunnybrook's hand-hygiene efforts are paying off. It showed health-care workers washed their hands 60 per cent of the time when required, which is higher than the nationally cited figure of 40 per cent.
“We need to sustain and improve on that,†Dr. Vearncombe said. “We all want to be 100 per cent. If we could get at 90 per cent, I'd be thrilled.â€
The low-tech solution – hand washing to prevent infections – is a hot-ticket item in hospitals. So far, 150 of 158 hospital corporations have attended or are registered for one of the 15 training sessions of Ontario's Just Clean Your Hands program, according to its project manager, Liz McCreight. Eligible facilities include acute-care hospitals, mental-health facilities and rehab hospitals.
As part of that program, designated trainers in hospitals are shown how to teach hand hygiene to their staff. The results of compliance are to be shared among individual hospital units.
“This thing is really about making a system change to make sure that they have what they need when they need it to perform hand hygiene,†said Ms. McCreight, adding that making alcohol-based hand gel easily accessible is also part of the solution.
Phil Hassen, chief executive officer of the Canadian Patient Safety Institute, said while mandatory hand-hygiene audits are important, “we do need some monitoring of infection rates, because in the end you need to know whether you are actually making a difference or not.â€
Pamela Fralick, president and chief executive officer of the Canadian Healthcare Association, predicted most health-care facilities would embrace the new requirement, as the benefits far outweigh costs.
“This is an era of accountability and patient safety,†she said in a telephone interview from Ottawa. “The two go hand in hand.â€
Hand hygiene
When performed correctly, hand hygiene is the single most effective way to prevent the spread of communicable diseases and infections.
In health care, hand hygiene is required:
- Before and after contact with patients, their body substances or items contaminated by them.
- Between different procedures on the same patient.
- Before and after performing invasive procedures.
- Before preparing, handling, serving or eating food or feeding a patient.
- After assisting patients with personal care.
- Before putting on and after taking off gloves.
- After performing personal functions such as using the toilet and blowing the nose.
- After hands have come into contact with secretions, blood and other body fluids. Source: The Community and Hospital Infection Control Association of Canada
-----------------------------------------------------------
Hospitals face hand-washing crackdown
Amid growing concern over spread of infection, watchdog demands hygiene audits and compliance plans from acute-care facilities
LISA PRIEST
From Tuesday's Globe and Mail
May 20, 2008 at 2:00 AM EDT
Canadian hospitals seeking accreditation will soon be required to audit whether their doctors and nurses are washing their hands – and are expected to do something about it if they are not.
Beginning next January, Accreditation Canada will compel virtually all acute-care hospitals – in addition to those nursing homes and other facilities seeking stamps of approval – to not only do hand-hygiene audits but to have a plan to maintain or improve hand-washing compliance.
Not even hospital volunteers will be exempt: They and hospital staff will be trained on how to properly wash their hands and to know when it is required.
“Clearly, hand hygiene is a very important step in the prevention and/or control of spread of infection,†said Wendy Nicklin, president and chief executive officer of Accreditation Canada, formerly known as the Canadian Council on Health Services Accreditation, a non-profit, independent organization. “ …We're at the point where we can't afford not to do it.â€
No wonder: With only 40 per cent of health-care providers in Canada properly washing their hands, experts say, infection prevention has become a hot-button issue.
An estimated 220,000 people develop hospital-acquired infections in Canada each year; at least 8,000 patients are killed by them, roughly the same number as those who die from car accidents and breast cancer combined. And yet, half of all infections could be prevented through proper hand hygiene, experts say.
Although accreditation is a voluntary process, 99 per cent of Canada's acute-care hospitals participate in it, as do many nursing homes, some community health centres, home-care organizations and other health-care facilities. Accreditation Canada accredits 3,515 sites of 995 organizations.
By compelling hospitals and other health-care facilities to do hand-hygiene audits, the organization is following the lead of other countries. In the United States, hospitals not only face similar audits, but health-care providers are required to cleanse their hands 90 per cent of the time when it is warranted, such as before and after seeing a patient.
“It's high,†said Louise Kuhny, senior associate director of the standards interpretation group of the Joint Commission, a non-profit organization that accredits and certifies U.S. health-care organizations, of the 90-per-cent hand-hygiene compliance rate. “And it's a big requirement but we feel that it's important because clearly infections are directly related to this.â€
Michael Gardam, director of infection prevention and control for Toronto's University Health Network, said most hospitals do not have the resources to do the labour-intensive auditing – something that will likely change with the new requirement.
Typically, auditing involves dispatching a roaming posse of hand-hygiene workers with clipboards to discreetly observe whether health-care providers are washing up.
“By making it mandatory, they will need the resources to be able to do the audits, which in my mind is really important,†said Dr. Gardam, who heads MRSA intervention for Safer Healthcare Now!, a national group that helps implement safer health-care practices in hospitals.
The problem of poor hand hygiene has confounded some of the best scientific minds in search of a solution. There have been poster campaigns and buttons. Hospitals have even doled out Tim Hortons coupons as a reward to health-care workers who scrub up. Some of the problem has been attributed to a perception deficit: Many health-care workers think they are already doing a good job of washing their hands.
In an effort to prevent infections, some hospitals have even instituted bans. At Sunnybrook Health Sciences Centre in Toronto, artificial fingernails, long natural nails and rings with stones are forbidden; no staff member providing direct patient care can wear them.
Bracelets that dangle past the wrist near the hand are another no-no, save for religious reasons. Even in those cases, the bracelets must be pushed up on the arms and kept in place. Plain wedding bands are discouraged but not banned.
Mary Vearncombe, Sunnybrook's medical director of infection prevention and control, said the bans are based on scientific evidence. Artificial nails, for example, trap moisture and can harbour yeast and gram-negative bacteria such as Pseudomonas aeruginosa.
“There have been some patients who have died, babies who have died [in North America], traced back to artificial nails,†said Dr. Vearncombe, who is also chairwoman of the provincial infectious diseases advisory committee's subcommittee on infection prevention and control in Ontario.
If the last audit, done in March, is any indication, Sunnybrook's hand-hygiene efforts are paying off. It showed health-care workers washed their hands 60 per cent of the time when required, which is higher than the nationally cited figure of 40 per cent.
“We need to sustain and improve on that,†Dr. Vearncombe said. “We all want to be 100 per cent. If we could get at 90 per cent, I'd be thrilled.â€
The low-tech solution – hand washing to prevent infections – is a hot-ticket item in hospitals. So far, 150 of 158 hospital corporations have attended or are registered for one of the 15 training sessions of Ontario's Just Clean Your Hands program, according to its project manager, Liz McCreight. Eligible facilities include acute-care hospitals, mental-health facilities and rehab hospitals.
As part of that program, designated trainers in hospitals are shown how to teach hand hygiene to their staff. The results of compliance are to be shared among individual hospital units.
“This thing is really about making a system change to make sure that they have what they need when they need it to perform hand hygiene,†said Ms. McCreight, adding that making alcohol-based hand gel easily accessible is also part of the solution.
Phil Hassen, chief executive officer of the Canadian Patient Safety Institute, said while mandatory hand-hygiene audits are important, “we do need some monitoring of infection rates, because in the end you need to know whether you are actually making a difference or not.â€
Pamela Fralick, president and chief executive officer of the Canadian Healthcare Association, predicted most health-care facilities would embrace the new requirement, as the benefits far outweigh costs.
“This is an era of accountability and patient safety,†she said in a telephone interview from Ottawa. “The two go hand in hand.â€
Hand hygiene
When performed correctly, hand hygiene is the single most effective way to prevent the spread of communicable diseases and infections.
In health care, hand hygiene is required:
- Before and after contact with patients, their body substances or items contaminated by them.
- Between different procedures on the same patient.
- Before and after performing invasive procedures.
- Before preparing, handling, serving or eating food or feeding a patient.
- After assisting patients with personal care.
- Before putting on and after taking off gloves.
- After performing personal functions such as using the toilet and blowing the nose.
- After hands have come into contact with secretions, blood and other body fluids. Source: The Community and Hospital Infection Control Association of Canada
