Canadian Survey Reports Shocking Non-Compliance

Article by Paula Carlson - Associate Editor of the Surrey Leader
Apr 06 2007

Results from a recent audit that examined hygiene in Fraser Health Authority hospitals in Canada is shocking at best and life-threatening at worst. The 2005 survey had nurses in emergency departments, intensive care wards and surgical units observe whether hospital staff and visitors properly washed their hands before contact with a patient. Two-thirds did not.

While visitors and family members of patients could plead ignorance (although the benefits of hand hygiene are widely known and are shared with the great unwashed starting as early as kindergarten), health professionals have no excuse.

It was after all, a physician – Dr. Ignaz Semmelweis – who in the late 1840s first demonstrated the connection between dirty hands and disease. He wondered if the high rate of maternal death in childbirth (up to 25 per cent) was linked to medical students delivering babies directly after leaving the autopsy table. Semmelweis insisted the students wash their hands before assisting women in labour, and the mortality rate dropped dramatically – to less than one per cent.

Today, centres for disease control around the world view hand washing as the single most important means of preventing the spread of infection. Not expensive antibiotics or vaccines, just a simple bar of soap and warm water.

So surely, the low rate of hand washing in hospitals can be attributed to uneducated lay people? Unfortunately, survey results rinse that notion down the drain. Three-quarters of health professionals did not properly wash before performing an invasive procedure, such as drawing blood, intubating a patient or inserting a catheter. And after? Nearly half didn’t clean up.

This is disturbing, and dangerous. With so-called “superbugs” on the rise and highly contagious illnesses such as Norwalk and C. difficile circulating more frequently, proper personal hygiene in health care facilities is crucial.

The elderly, children, pregnant women and those with weakened immune systems are especially vulnerable to infections that could be stopped in their tracks by a trip to the tap. Yet approximately one in nine patients contract infections during their stay in hospital, and about 8,000 Canadians die of hospital infections each year.

By extension, one wonders: how many other industries with cleanliness as a priority are equally remiss?
For example, inadequate hand washing is blamed for up to 40 per cent of all food poisoning cases.
The poor performance in hospitals, however, remains the most troubling.

The B.C. government agrees, saying the $130,000 spent on an education campaign to teach front-line health workers in the Vancouver Island Health Authority how to wash their hands properly is money well spent. The announcement in February appeared ludicrously obvious, but now, seems suddenly imperative.

FHA spokesman Stephen Harris recently suggested patients also have a role to play, saying before submitting to treatment they shouldn’t be afraid to ask nurses and doctors if they have properly washed up.

Perhaps the principal and ancient tenet of medicine still imparted to modern medical students – primum non nocere, or first, do no harm – should be updated. How about: Physician – first, wash your hands.