Capital Health reporting hand hygiene compliance rates

Wednesday, May 29, 2013 - 2:07pm

*As of May 29, 2013, rates for hand hygiene compliance and C. difficile across the province are available online at the Department of Health and Wellness.

Capital Health has been reporting this information for several years. See the latest reports.


It’s 8 a.m. on a busy inpatient unit at the QEII Health Sciences Centre.

Every bed is full, visitors are popping in and medical staff are checking on patients while physicians do their rounds.

Watching it all with a keen eye are two people from Capital Health’s Infection Control Unit. They are on a hand hygiene audit.

Suzanne Hennessey and Tammy MacDonald, hand hygiene auditors, come unannounced. They simply stand and watch, one with a laptop, one with a pen and paper. They make a note every time they see a staff member wash their hands or use sanitizer. More importantly, they also record every time they don’t.

“We’re not exactly under cover,” explained MacDonald. “Everyone knows who we are and why we’re here. When we first arrive everyone becomes extra vigilant. But then they sort of forget we’re here, they get back in their routine and we get a true snapshot of what life on the unit is like.”

Keeping watch

Capital Health, like many other health authorities and hospitals around the world, keeps a close eye on hand hygiene. Dangerous and even deadly bacteria spread from person to person through personal contact.

The Ontario Medical Review says the infections from these bacteria are the fourth-leading cause of death in Canada, surpassed only by cancer, heart disease and stroke.

Most of these infections are preventable.

“Many strains of bacteria can last a long time on surfaces and hands and keeping hands clean is the best thing you can do to prevent bacteria from spreading,” explained Hennessey. “We are there to audit what’s happening, to educate and coach staff and to congratulate them when they do a good job.”

The Canadian Patient Safety Institute recommends that health-care workers should clean their hands during the 4 Moments for Hand Hygiene.

“That is a lot of hand cleaning in a short period, sometimes only five minutes,” explained MacDonald. “Bacteria and germs are invisible, but trust me, they are there. We just have to remind care providers that they are protecting themselves and patients.”

On an audit, Hennessey and MacDonald can only record what care providers do before going into a patient’s room and after they leave. They don’t go inside, to protect patient privacy. The pair will stay until they have witnessed, on average, 50 hand hygiene moments. Audits are conducted four times a year, for most inpatient units within Capital Health.

Lack of compliance  

The World Health Organization says the lack of compliance among health-care providers is problematic worldwide. The reasons vary: from lack of time, to skin irritation caused by sanitizer, to skepticism and forgetfulness. There are even reports of staff saying constant hand washing interferes with a good patient relationship.

And then there’s the glove issue.

“People put on gloves and think the problem is solved. But bacteria lives on gloves, and gloves can sometimes have tiny holes that spread infection,” said Hennessey. “The truth is you have to wash just as much with gloves; before and after every time you take an old pair off and put a new pair on.”

Along with audits, Hennessey and MacDonald spend a lot of their time trying to educate Capital Health’s 12,000 staff. They recently started a Hand Hygiene Champion program to recognize role models from all departments. They do hand washing sessions, send out staff emails and are constantly available to train and retrain staff.

Posting audit results is another way to remind staff how they are doing and to keep the public informed.

Capital Health has been reporting compliance rates on the internet since 2010 and starting in May 2013, publicly posting these rates will become law through the introduction of the Patient Safety Act. Hand hygiene compliance rates from every hospital in Nova Scotia will be available on the Department of Health website.

After an hour, the auditors at QEII wraped up their audit, concluding staff members were complying about 91 per cent of the time. Capital Health’s overall rate for the last quarter was 62 per cent. Nationally, the average rate of compliance is about 40 per cent.

“Is 62 per cent good enough? Of course not,” says MacDonald. “But it’s better than it was. It takes a lot of work, a lot of persistence and a lot of monitoring to get those numbers up.” 


Capital Health has several ongoing strategies to educate staff and increase compliance including the Hand Hygiene champion program, education and training.