Fewer hospital staff sanitize their hands when there’s no one looking than when they know they’re being watched.
The findings from a new British Medical Journal Quality and Safety reportconducted by a team of Ontario researchers, raises concerns about the effectiveness of hand-hygiene programs.
The study, co-authored by McMaster University assistant professor Dr. Jocelyn Srigley, used sanitizer and soap dispenser electronic sensors plus staff auditors to monitor an Ontario acute-care hospital for eight months.
They found a three-fold increase in cleansing compliance when staff could see an auditor watching them in the hall.
“What surprised us was the magnitude of the effect,” said Srigley, an associate medical director of infection prevention and control with Hamilton Health Sciences.
“Behaviour is a huge black box in the infection-control world,” she said. “Hospitals like to put out guidelines, but few look at behaviour.”
Alternative approaches, such as replacing top-down management policy with strategies that get frontline staff to develop their own solutions could help, she said.
Srigley’s next study will examine how often hospital patients wash their hands.
The report comes as another Ontario hospital study found hospitalelevator buttons are one of the filthiest surfaces in hospitals, with more germs than toilet stalls.
That Sunnybrook Health Sciences Centre researchers report, published in the July issue of Open Medicine, found 61 per cent of 120 buttons tested were covered in bacteria, compared to 43 per cent of 96 toilet stall surfaces — door handles, latches and flush levers — that were tested.
Fortunately, most of the elevator bacteria identified in the three Toronto hospitals weren’t harmful.
B.C.’s current hygiene policy is set out in the Ministry of Health’s 2012 B.C.’s Best Practice Guidelines for Hand Hygiene.
The ministry requires all health authorities to meet standards in hand-washing policy, reporting, auditing, and quality assurance in all acute-care and long-term, assisted living and residential-care settings.
The health authorities must run hand-hygiene programs, meet a minimum 80 per cent compliance rate, then submit quarterly compliance reports to the Provincial Infection Control Network.
Hand-washing audits of long-term care, assisted living and residential-care facilities will become available in 2015.