Handwashing Policies in Place but Monitoring Hand Hygiene Remains a Challenge

According to a new analysis from the Canadian Institute for Health Information (CIHI), 99 percent of the 103 Ontario hospitals participating in a 2008 patient safety survey reported that they had a formal hand hygiene policy in place, and just more than one-third of these (38 percent) established an auditing process to ensure that proper handwashing procedures are being followed. Hand hygiene is recognized in Canada and internationally as a top patient safety priority measure in preventing the spread of infections, and auditing is a key component in ensuring observance of hand hygiene policies.

Community hospitals were the most likely facility type to have a formal mechanism in place for auditing hand hygiene practices (47 percent), followed by teaching hospitals (35 percent) and small hospitals (19 percent). Among hospitals without formal inspection procedures, more than half (59 percent) reported that one will be developed in 2008, with full implementation planned for 2009.

“In recent years, limiting the spread of hospital-acquired infection has become a major focus of patient safety campaigns across the country,” says Dr. Michael Gardam, medical director at the University Health Network in Toronto. “The results of this survey offer a rare chance to see how these campaigns are changing the culture of Ontario’s hospitals and creating a safer environment for patients.”

Many Ontario hospitals have implemented hospital infection control programs, appointing professionals with infection prevention and control training and expertise. These professionals work with an organization to prevent healthcare-acquired infections (HAIs) by educating staff, planning and implementing infection control practices and evaluating existing policies and procedures. In 2008, 80 percent of hospitals reported having either a certified infection control practitioner (ICP) or a physician/doctoral professional trained in infection control as part of their infection control program. Successful programs emphasize the importance of having both, and the survey showed this was the case in 42 percent of participating hospitals.

The presence of infection control experts varied by hospital type; all teaching hospitals reported that their program included a physician or doctoral professional trained in infection control, compared to 56 percent of community hospitals and 26 percent of small hospitals. A greater proportion of teaching hospitals reported that they have an ICP certified by the Certification Board of Infection Control (CBIC) as part of their infection control program compared to community and small hospitals.

Many studies show that active surveillance of hospital-acquired infections can help contain their spread. Of hospitals participating in the survey, 98 percent reported that they routinely track cases of hospital-acquired infections within their hospital. Approximately three out of four hospitals (74 percent) reported that they most commonly use hospital-wide surveillance to routinely monitor the incidence of nosocomial infections, compared to targeted surveillance of specific areas of the hospital. These results varied by hospital type: small and community hospitals largely use hospital-wide surveillance (84 percent and 78 percent, respectively), whereas teaching hospitals use hospital-wide (47 percent) and targeted surveillance (53 percent) equally.

Almost all hospitals indicated that they reported the incidence of “superbug” infections, either internally or publicly. At the time the survey was completed, 96 percent of hospitals indicated reporting for methicillin-resistant Staphylococcus aureus (MRSA), 95 percent for vancomycin-resistant enterococci (VRE) and 95 percent for Clostridium difficile (C-difficile). New mandatory reporting legislation enacted by the Ontario Ministry of Health and Long-Term Care means that as of Sept. 26, 2008, public reporting of all C. difficile cases is mandatory in Ontario healthcare facilities. VRE and MRSA cases will be reported publicly by Dec. 30, 2008.

“Nobody wants patients to become more unwell while being treated in hospital,” says Dr. Indra Pulcins, director of health reports and analysis at CIHI. “Better information on current infection control practices and policies, as well as information about the incidence of hospital-acquired infections, will provide further direction for the development of new procedures into the future.”

Source: Canadian Institute for Health Information (CIHI)