Hand Washing Compliance in Health Care Is Probably Grossly Over Reported — a Canadian Hospital Study Estimates that the Actuality Is Three Times Less

09 July 2014

Citation — to study

Jocelyn A Srigley, Colin D Furness, G Ross Baker, and Michael Gardam, Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study, BMJ Quality & Safety, DOI:10.1136/bmjqs-2014-003080 (online first, 07 July 2014)

Citation — to press release

Alex Radkewycz, Healthcare Worker Hand Hygiene Rates Increase Three-Fold when Auditors Visible, University Health Network (08 July 2014)

As a medical patient, you cannot go self-defensively wrong by tentatively assuming that health care workers and providers are stupid, lazy or simply sloppy

Based on significant personal experience, I imagine that these findings apply in the United States, as well as to Canada, where the study was conducted:

Hand hygiene rates were found to be three times higher when auditors were visible to healthcare workers than when there were no auditors present, according to a study in a major Canadian acute care hospital.

Two inpatient units in University Health Network were electronically monitored, with 60 healthcare workers volunteering to be part of a study of the electronic monitoring system.

Staff were aware that data would be used in a variety of studies, but were "blind" [meaning that they did not know] to the questions asked in the studies.

Auditors did not announce their presence during audits but wore white lab coats. Auditors were also blinded to the questions asked in the research.

Hand hygiene dispenses were electronically measured while the auditors were visible, and were compared to the same locations prior to the arrival of the auditors at one, two and three weeks before the audit, as well as to a different area of the unit not visible to the auditor.

Auditors typically did not go into patient rooms, so separate hand washing rates were determined for dispensers inside patient rooms and those in hallways. Twelve audits were included between November 2012 and March 2013.

The study found that there was an approximately three-fold increase in the rate of hallway hand washes per hour amongst healthcare staff when an auditor was visible (3.75 per hour), compared to a location where the auditor was not visible (1.48 per hour) and to the previous weeks (1.07 per hour).

In each instance, the hand washing rates were significantly higher when the auditors were present, with the increase occurring after the auditors' arrival, suggesting that the arrival of the auditor triggered the increase in hand hygiene.

"The difference in hand hygiene rates, when an auditor is present compared to those times when one is not, is huge in this study, and we showed this effect to be very consistent," says Dr. Gardam, who is also an Associate Professor of Medicine at the University of Toronto.

Why this matters

Health care is filled with self-reporting and self-correction protocols — as well as by an egregious dose of self-righteous arrogance that questions the motivations of those who question the workability of letting “professionals” do whatever they want.

My medical training persuaded me that most of this is camouflaging BS aimed at guarding profits and avoiding the imposition of effective monitoring.

Medical care is like everything else. A high proportion of people in the business will get away with whatever they can, even when that sloppiness causes (usually partially hidden or deliberately concealed) damage to patients.

In summarizing perspective

We have known for decades that hand washing is one of the best ways to prevent infections and infectious diseases from spreading. Now that the Antibiotic Age is scarily drawing to a close, hand washing in medical settings is especially important.

That a high proportion of these “clowns” are still running around with hands that would make Ignaz Semmelweis cringe is tribute to the ineradicable nature of human stupidity and callousness.

Obvious caveats

Obviously, this study is limited. Sixty providers and workers, and two inpatient units in one hospital system, carry almost no statistical power outside its confines.

On the other hand, a conscientiously undertaken effort

(i) The study was permitted by a hospital system apparently seeking to improve itself

and

(ii) carried out by medical people, who wanted to find actuality, rather than parrot previously accepted propaganda:

The study . . . [is] by first author Dr. Jocelyn Srigley, who did the study as part of her Master's thesis while a Clinical Fellow in Infection Prevention and Control at University Health Network and University of Toronto and senior author Dr. Michael Gardam, Director, Infection Prevention and Control, University Health Network and Women's College Hospital.

The moral? — As a patient, do not initially assume that your medical providers and health care workers know (or care) what they are doing

Laziness is everywhere. In their unconscious minds, these casually “unclean” health care workers will not be seeing you again, whether you are recovered or dead. And who will know that they (might have) contributed to your demise?

The best medical providers and workers are self-motivated and anally conscientious (in the popularized Freudian sense). These types are, unfortunately, proportionately few. The rest are, effectively speaking, just making a buck or operating at the limits of their arguably picayune abilities. How hard, after all, is washing one’s hands?

Keep this Canadian study in mind, while you watch a medical provider or associated worker put unwashed, (often antibiotic resistant) germ-conveying hands on your body.

If vigilant, you can be the “visible auditor” in many instances of your own health care.

PeteFree.com

Hand Washing Compliance in Health Care Is Probably Grossly Over Reported — a Canadian Hospital Study Estimates that the Actuality Is Three Times Less