hand-hygiene-pub-domainThis July, a group of researchers from the University of Toronto and Sunnybrook Health Sciences Centre released a study addressing the question “Do physicians clean their hands?” The answer is critical to improving patient safety in Canada and lowering rates of hospital malpractice.

The question has, in theory, already been answered: designated auditors regularly inspect hand hygiene practices in healthcare institutions across Canada. In Ontario, hospitals generally report hand hygiene compliance rates of around 90 per cent. However, this practice comes with a fairly obvious flaw: physicians are usually aware they are being observed.

As Dr. Jerome Leis, the study’s lead author, points out, “the current measurement and reporting system for hand hygiene rates overestimates how often healthcare providers clean their hands, because it doesn’t account for the natural changes in behavior that happen when healthcare providers know they are being watched.”

To avoid this natural change in behavior, which is known as the “Hawthorne effect,” Dr. Leis’ team trained two students to act as covert hand hygiene observers during their clinical rotations at Sunnybrook, according to Hospital News. The study’s initial aim was to identify hand hygiene performance gaps between physicians and other healthcare professionals. It also aimed to form a clearer picture of hygiene practices – which can, in some circumstances, result in hospital malpractice – in hospitals across the country.

“Physicians are often reported to have much lower hand hygiene compliance than other healthcare providers,” Dr. Leis told Hospital News. “We wanted to find out whether this group was truly less likely to clean their hands, or if lower compliance rates among physicians were because of issues with the observational method itself.”

The students conducted observations in Sunnybrook’s emergency department, general medical ward, and surgical ward between May 27 and July 31, 2015. Over that time, they reported “much lower [hand hygiene] compliance than recorded by hospital auditors: 50.0% versus 83.7%.” Surprisingly, the observations also revealed a lower rate of compliance among nurses than physicians.

“These findings show that hand hygiene is a problem across all groups of healthcare providers, not just physicians,” Dr. Mary Vearncombe, one of the study’s co-authors, told Hospital News.

According to a July 2016 National Post article, infections contracted in Canadian hospitals lead to an estimated 8,000 deaths per year, and healthcare providers’ contaminated hands are thought to be a primary delivery system. Improved hand hygiene compliance throughout Canada’s healthcare system could have a powerful beneficial impact on patient safety, and could lead to fewer instances of hospital malpractice.

“There is no question that at a national level, both our surveillance for hospital-acquired infection and our surveillance for anti-microbial resistance is not serving our needs,” Allison McGeer, an infectious disease specialist at Mount Sinai Hospital, told the Post in 2015. “We know, very substantially, that you can’t fix what you’re not measuring.”

Dr. Leis’ team is now working with several hospitals in the Greater Toronto Area to test and implement new hand hygiene measurement practices, including electronic monitoring. But while automated systems may communicate more accurate results, they lack the in-the-moment feedback and educational opportunities of direct observation, Dr. Vearncombe pointed out.

“Different methods for measuring are complimentary, not mutually exclusive,” Vearncombe said.

If you or a member of your family has suffered a serious injury or sickness as a result of medical or hospital malpractice, contact the Medical Malpractice Group at Neinstein Personal Injury Lawyers today for a free, no-obligation consultation. You may be entitled to compensation.

Greg Neinstein