Hand-washing: A patient safety issue

Every year, one in six Canadians admitted to hospital develops a health-care associated infection; between 8,000 and 12,000 die. Obviously, both patients and health-care providers must be protected and, at St. Joseph’s Health Centre, that meant investigating the specific challenges caused by the environment itself to improve hand hygiene compliance and reduce health-care associated infections.

“St. Joseph’s is getting serious about hand hygiene,” says Nadine Agard, one of the two leads on the hospital’s hand hygiene program. “People see hand hygiene as basic practice, but for us it’s about putting patients first and providing the safest care.”

The program was initiated in response to the World Health Organizations’ Clean Care is Safer Care program, launched in 2005, aimed at reducing health-care associated infections.

Reports suggest hand hygiene improvements could reduce infection rates by up to 50 per cent. Following an initial Facility Preparedness Phase, which included a “train-the-trainer program” and an evaluation of hand hygiene resources, a pilot study was launched in two units, both very different. “One presents near perfect physical features for what a patient room should look like while the other is challenging, so that, when we roll out the program to the rest of the organization, we have expertise on both types of unit structure,” explains Agard. “This included an ergonomic evaluation and assessment of hand hygiene resources, such as sink heights and hand hygiene products, at the point of care.”

Now that the strategy has officially been launched, posters and other visual hand hygiene reminders have been placed throughout the hospital. A vendor fair was conducted to provide all employees and physicians at the health centre with the opportunity to sample and evaluate a range of hand hygiene products, including hand rubs, lotions, soaps and dispenser units. The analysis of this information will ensure that the best products are chosen, with input from the people that will be expected to practice proper hand hygiene.

“We want our patients and our community to be part of our campaign,” explains Agard.

It’s the ability to tailor the Ministry of Health and Long-Term Care’s Just Clean Your Hands strategy to specific hospitals that makes the program so successful and will create change through a complete overhaul of the hand hygiene culture in Ontario hospitals.

The Just Clean Your Hands program is multi-faceted, so that it goes beyond merely sticking up a few posters on a wall. The program includes a step-by-step guide, training sessions for hospital staff, online training modules, a methodology for placement of hand hygiene products at point of care, visual supports and an audit tool to measure compliance rates. The goal is to fully integrate hand hygiene into the workplace culture.

The next step at St. Joseph’s Health Centre is a full roll out of the program, once the piloting phase comes to an end. The hope is to have a full-scale revolution in the hand hygiene culture at the Health Centre. With the support of the Just Clean Your Hands program, the effects of this revolution will be much more easily measured and sustained.