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Frequently Asked Questions 
 
                                                                                                                  
 
Who was audited and where?

Eastern Health’s Infection Prevention and Control Program (IPAC) audited clinical inpatient units at 27 acute care and long-term care facilities throughout the eastern region, with the exception of operating rooms, case rooms and ambulatory clinics. During this audit, the Emergency Departments were also included for the first time.

When was the audit conducted?

June-September 2012.

What was the overall level of compliance?
 
The overall level of compliance was 49 per cent. This includes the results for the Emergency Departments, which were not included in the first hand hygiene audit conducted in 2011. A comparison with the results between 2011 and 2012, not including the Emergency departments, shows that the overall compliance rate went from 52.6 (rounded to 53) per cent in 2011 to 51 per cent in 2012. The audit measured hand hygiene practices performed at two moments in time: before and after contact with the patient and/or patient environment.

Were there any improvements in compliance?
 
There were examples of considerable improvement in the area of long-term care. Four Eastern Health long-term care facilities met or exceeded the 80 per cent target: Interfaith Citizen's Home in Carbonear, the Salvation Army Glenbrook Lodge in St. John's, Lions Manor Nursing Home in Placentia and Masonic Park Nursing home in Mount Pearl. The overall compliance rate for all the long-term care facilities was 58 per cent.
 
How do these rates compare with national rates?
 
National rates vary from facility to facility and from province to province; however, according to the Canadian Patient Safety Institute, the national rate of hand hygiene compliance is less than 40 per cent.
 
What are the risks of non-compliance?
 
Absence of hand hygiene practice will result in the increased transmission of antibiotic resistant organisms (AROs) and increased infections. This in turn will increase the length of hospital stays and costs which will result in a decrease of available beds and an increase in the wait list for hospital procedures.

What has EH done to increase awareness and compliance?

Prior to the first audit in 2011:

  • Eastern Health’s Infection Prevention and Control Program (IPAC) conducted ongoing hand hygiene education and awareness initiatives, including the use of hands-on tools, posters and pamphlets, and presentations to various clinical programs and at orientation sessions; including a mandatory session for all staff on hand hygiene.
  • In 2010, a campaign known as Dare to be Bare: Below the Elbows informed staff that in order to wash their hands properly they had to roll up their sleeves, remove jewelry and nail enhancements and also encouraged proper hand hygiene practices when in direct contact with patients and clients.
  • IPAC also conducted a review on the number of wall mounted hand hygiene alcohol based hand rub (ABHR) stations within the facilities and these were increased in all sites. All programs were advised by IPAC to purchase individual ABHR bottles so staff could avail of these at point of use.

After the 2011 Audit:

  • IPAC’s Infection Control Practitioners (ICPs) met with Eastern Health’s program managers and encouraged them to discuss hand hygiene as a safety priority with staff and as everyone’s responsibility.
  • IPAC continued to provide education and awareness, including the launch of an IPAC newsletter; provided ‘Glo-Germ’ demonstrations on proper hand washing and placed a Canadian Patient Safety Institute (CPSI) Hand Hygiene e-learning module on computers in many clinical areas for completion by staff. IPAC also provided training at the nursing unit level on the 4 Moments of Hand Hygiene, which was reinforced with the placement of posters in the clinical areas.
  • IPAC collaborated with a unit at St. Clare’s Mercy Hospital, to enroll in a Patient Safety Collaborative called ‘Stop Infections Now.’
  • Hand Hygiene was promoted throughout Eastern Health during Stop, Clean your Hands Day in May 2012 and during IPAC week in October 2012, and the IPAC Program worked with the Provincial Government to promote hand hygiene on a provincial level with a poster entitled ‘Scrub up!’

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Why aren’t staff members complying?
 
This is what Eastern Health is attempting to determine. It is well known in health care circles that non-compliance with hand hygiene is directly linked to the increased spread of infection, and quality and safety has also been identified as a strategic priority in Together We Can – Eastern Health’s Strategic Plan 2011-2014. These results do not mean that staff members are not washing their hands at all; it means that they are not washing hands often enough; that is, before and after contact with patients and/or the patient environment. Many health care professionals honestly believe they are washing their hands enough or doing it more often than they are.
 
It is also possible that some do not recognize the real implications of non-compliance, despite the all the education and public awareness around the issue.

Given that the audit was conducted during this past summer, why has it taken so long to release the results?
 
This was due to the time-consuming nature of thousands of visual observations, done via manual recording and documentation. All audits are done by direct observation, manually recorded on an audit tool, entered into a database, and then collated and analyzed in order to generate a report. This report is then checked and re-checked for errors.

Where does Eastern Health go from here?
 
Eastern Health takes the results of this hand hygiene audit very seriously. The Director of Infection Prevention and Control will work with Eastern Health's Safety Health Network Committee and a Regional Hand Hygiene Committee to develop and implement an action plan aimed at effecting a cultural change regarding hand hygiene.

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Updated Mar 18, 2013