Home' Inclean NZ : INCLEAN NZ May 2017 Contents 24 INCLEANNZ May 2017
I have read some very interesting peer
reviewed publications recently, particularly
with Hand Hygiene day this month. The
infection prevention principles effect
everyone in involved in the clinical care of
patients. A short review of each paper is
Firstly, in the December issue of the
American Journal of Infection Control
an Australian team published some data
on the serious silliness around hand
The corresponding author was Professor Mary Lou McLaws
from the University of NSW. This study used both overt and covert
surveillance of hand hygiene compliance (HHC) and compared the
outcomes to the official record of HHC from the state-based NSW
State Clinical Excellence Commission.
The official rate for one site was 87 per cent HHC, while another
was 85 per cent HHC. These results are pretty good (the pass level is
just 70 per cent compliance, according to Hand Hygiene Australia).
As an aside, can you imagine if the flight captain on your next
trip across the ‘ditch’ commenced the trip with the happy news
that there was a 87 per cent chance you would get to your intended
destination without crashing, which is better than the expected safe
arrival rate of 70 per cent?
Perhaps you might get off before the plane got into the air! The official
successful arrival rate for commercial airliners is expected to be 100 per
cent so why should it be acceptable that health care workers only have to
wash their hands on seven out of 10 times that they should be washed?
Anyway, the official rate was established with ‘overt’ surveillance using
the traditional auditor standing and watching people wash their hands.
The covert data was frightening. The compliance rates for the two
sites were in fact just 30 per cent and 49 per cent. That means that on
every occasion when a healthcare worker touched a patient or patient
surrounds, there was a better than 50 per cent chance that they had
not washed their hands in compliance with the requirements of the
international best practice standards. If this was a food premises each
non-compliance event would result in an on-the-spot fine of around
$330 per incident for everyone.
So, the research team tested an ‘intervention’ to see if the real rates
were improved. Terrifyingly one of the sites saw no improvement,
while the other lifted HHC to around 60 per cent. However,
once the intervention ceased, the washout period results perfectly
matched the initial outcomes.
Secondly, there was a very interesting paper in the March issue of
the American Journal of Infection Control, which compared the
presence of multi resistant Clostridium difficile (C. difficile) on floors
in rooms with C. difficile infected patients, with the floors of non-
infected patient rooms.
The researchers also recovered for both MRSA and VRE from the
same floors. What was surprising was the frequency of coincidentally
high levels of both MRSA and VRE in the C. difficile patient room
floors. So, what happens when those patients start walking around with
their disposable and non-slip socks, and then they get back into bed?
Finally, in the December issue of the Journal of Hospital Infection
researchers in the UK looked at recovery organisms from the
disposable/non-slip socks that are used in hospitals.
Unsurprisingly, the socks were so contaminated that they nearly up
and walked by themselves. This matches rather nicely some work by
Professor Karen Vickery and her team at Macquarie University, who
demonstrated the ability of socks to transmit MROs and so contaminate
the bed with bugs collected from elsewhere – demonstrating that
hospital floors act as a sump and the socks as the fomite.
While it’s good to know that hygiene remains an important focus,
hand hygiene compliance remains a challenge for clinical care, just
as it was for Dr Semmelweiss back in the 1840s. The bugs spreading
around inside hospitals can jump up from the floor, and into the
bedding of an otherwise healthy individual.
Perhaps this should be a salutary reminder for all of us to wash our
hands regularly and to carefully manage our ambulatory patients. The
role for appropriate disinfection remains as important today as it did
for Dr Lister.
Greg Whiteley is director of Whiteley Corporation
By: Greg Whiteley*
Links Archive INCLEAN NZ Aug 2017 Navigation Previous Page Next Page