Doctors and nurses at a major Sydney hospital failed to properly wash their hands when no one was watching, risking patients' lives, a new study found.
Researchers from University of NSW found the staff's hand-washing compliance rate dropped from 94 per cent to 30 per cent when human auditors stopped monitoring their behaviour and automated surveillance kicked in.
They are calling for an overhaul of the auditing system, which may still require human auditors because automated surveillance and reminder technology are expensive, and the re-education of hospital workers about the importance of hygiene.
"Hand hygiene is the keystone to infection control that prevents healthcare workers from being colonised with a potentially life-threatening disease; that reduces hospital-acquired bloodstream infections that can kill up to 20 to 30 per cent of patients," lead author Mary-Louise McLaws said.
"Healthcare workers know how to respond when they’re being watched, but the rest of the time they go back to a dangerous level and I don’t blame them, no one's watching."
The results call into question the accuracy and effectiveness of Hand Hygiene Australia's (HHA) national program
which largely relies on human auditors and has shown an increase in
compliance from 64 per cent in 2010 to 84.4 per cent this year.
Between 2013 and 2017, cases of hospital-acquired 'golden staph', caused by Staphylococcus aureus bacteria, decreased by 12.5 per cent.
But Professor McLaws, an infection control expert, said the magnitude of the "Hawthorne effect" - the change in behaviour when people are watching - on human auditing produced "inflated" official compliance rates and all parties needed to go "back to basics".
The researchers used automated surveillance, which consisted of hand hygiene dispensers at sinks and bedsides that recorded hand hygiene by touch, to see how staff changed their behaviour. Compliance is based on the number of hand hygiene "moments" - opportunities when hand washing or cleaning ought to occur, whether before or after touching a patient.
Between 2013 and 2017, cases of hospital-acquired 'golden staph', caused by Staphylococcus aureus bacteria, decreased by 12.5 per cent.
But Professor McLaws, an infection control expert, said the magnitude of the "Hawthorne effect" - the change in behaviour when people are watching - on human auditing produced "inflated" official compliance rates and all parties needed to go "back to basics".
The researchers used automated surveillance, which consisted of hand hygiene dispensers at sinks and bedsides that recorded hand hygiene by touch, to see how staff changed their behaviour. Compliance is based on the number of hand hygiene "moments" - opportunities when hand washing or cleaning ought to occur, whether before or after touching a patient.
The
study found the compliance rate dropped from 94 per cent to 30 per cent
in the medical ward and 86 per cent to 55 per cent in the surgical ward.
“To date, no one has attempted to quantify potential errors in compliance rates,” Professor McLaws said.
"The healthcare workers need to have their behaviour flipped so that their hand hygiene is not centred on them and self-preservation but on the safety of others. We need a national behaviour change program."
HHA's Lindsay Grayson said the results from one hospital shouldn't be generalised to all 960 hospitals being audited across Australia.
“To date, no one has attempted to quantify potential errors in compliance rates,” Professor McLaws said.
"The healthcare workers need to have their behaviour flipped so that their hand hygiene is not centred on them and self-preservation but on the safety of others. We need a national behaviour change program."
HHA's Lindsay Grayson said the results from one hospital shouldn't be generalised to all 960 hospitals being audited across Australia.
He
said the "seriously concerning" results were "dramatic" because the
researchers used daily 20 minute human audits to establish the baseline,
instead of the HHA-recommended approach, which better reflects the
reality.
Their own studies showed the Hawthorne effect was, at maximum, 7 per cent.
"The National Hand Hygiene Initiative has been a tremendously successful and important infection control intervention in Australia, in fact, it has been repeatedly cited as the leading such national program anywhere in the world," Professor Grayson said.
"For hospitals that can afford these automated systems, they may serve as an adjunct to human-based auditing, but they cannot replace the human element of healthcare worker education and personal feedback, that we know is critical for healthcare workers to change their behaviour."
Their own studies showed the Hawthorne effect was, at maximum, 7 per cent.
"The National Hand Hygiene Initiative has been a tremendously successful and important infection control intervention in Australia, in fact, it has been repeatedly cited as the leading such national program anywhere in the world," Professor Grayson said.
"For hospitals that can afford these automated systems, they may serve as an adjunct to human-based auditing, but they cannot replace the human element of healthcare worker education and personal feedback, that we know is critical for healthcare workers to change their behaviour."
The
latest HHA audit data shows among major and large hospitals in NSW, 10
fell below the current national benchmark of 80 per cent compliance with
best practice hand hygiene.
Source