Handwashing Policies In Place In Virtually Every Hospital In Ontario, Canada, But Monitoring Hand Hygiene Remains A Challenge

Main Category: Public Health
Also Included In: MRSA / Drug Resistance;  Infectious Diseases / Bacteria / Viruses
Article Date: 30 Oct 2008 - 10:00 PDT

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According to a new analysis from the Canadian Institute for Health Information (CIHI), 99% 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%) 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%), followed by teaching hospitals (35%) and small hospitals (19%). Among hospitals without formal inspection procedures, more than half (59%) 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."

Appointing experts in creating safe surroundings

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 health care - acquired infections by educating staff, planning and implementing infection control practices and evaluating existing policies and procedures. In 2008, 80% 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% 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% of community hospitals and 26% of small hospitals. A greater proportion of teaching hospitals reported that they have an ICP certified by the Certification Board of Infection Control as part of their infection control program compared to community and small hospitals.

Infection surveillance programs

Many studies show that active surveillance of hospital-acquired infections can help contain their spread. Of hospitals participating in the survey, 98% reported that they routinely track cases of nosocomial (hospital-acquired) infections within their hospital. Approximately three out of four hospitals (74%) 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% and 78%, respectively), whereas teaching hospitals use hospital-wide (47%) and targeted surveillance (53%) equally.

Almost all hospitals indicated that they reported the incidence of "super-bug" infections, either internally or publicly. At the time the survey was completed, 96% of hospitals indicated reporting for methicillin-resistant Staphylococcus aureus (MRSA), 95% for vancomycin-resistant enterococci (VRE) and 95% for Clostridium difficile (C-difficile). New mandatory reporting legislation enacted by the Ontario Ministry of Health and Long-Term Care means that as of September 26, 2008, public reporting of all C-difficile cases is mandatory in Ontario health care facilities. VRE and MRSA cases will be reported publicly by December 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."

Reusing single use medical devices

The appropriate use of reusable medical equipment can be critical in preventing hospital-acquired infections. Medical devices labelled by the manufacturer as single use are meant to be discarded after one use. In Ontario, some single use medical devices are allowed to be used more than once if reprocessing (sterilization) is done by a licensed operator. While the majority of Ontario acute care hospitals (87%) do not reuse these devices, the survey found that of the hospitals that permit reuse of the devices following sterilization, teaching hospitals are the most likely to do so (29%) compared to community hospitals (12%) and small hospitals (4%).

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

Canadian Institute for Health Information