Hand washing in hospitals may keep super bugs away: Report

By Dr. Ananya Mandal, MDNov 10 2011

A recent survey of hospitals has shown that the successful implementation of good hand washing practices in hospitals by nurses and doctors is effective in reducing the drug resistant superbugs. This comes after the introduction of a national program to boost hand hygiene compliance rates in hospitals by encouraging staff to use alcohol-based hand rubs before and after treating patients. To make it easier for hospital workers to clean their hands, alcohol-based hand rubs are being installed at the foot or near the head of every bed.

The Australian National Hand Hygiene Initiative adopted by hospitals was based on the World Health Organisation's (WHO) advice for staff to clean their hands before and after touching a patient, having contact with their surroundings, and performing a procedure.

The audit of 521 hospitals found compliance rates rose to 67 per cent from 43 per cent in the two years since the program began in 2009. Alongside the number of patients being infected with the superbug Staphylococcus aureus, also known as MRSA or golden staph, dropped significantly.

According to director of Hand Hygiene Australia Professor Lindsay Grayson, who helped develop the program, clean hands were the best protection against superbugs like MRSA, which is resistant to antibiotics and spreads quickly through patient contact. He said while the drop in MRSA rates could not scientifically be proven by better hand cleaning it was “a hell of a coincidence”.

“We can't say for certain it's due to the hand hygiene program but it would appear that MRSA infections, which are the most dangerous sort, are at last declining,” said Prof Grayson, who also heads the infectious diseases department at Melbourne's Austin Health hospital.

However it seems from the Australian audit, published online by The Medical Journal of Australia today, doctors are lagging behind nurses in the hand-cleaning stakes. Nearly three quarters of nurses complied with hand hygiene rules compared to about half of all doctors. Nursing staff, including student nurses, were the most hygienic, reaching 73 per cent, while doctors and medical students lagged at 52 per cent, worse than any other workers.

Prof Grayson explained that the differences could be explained by the fact nurses handle patients more often than doctors and probably were more aware of the need for clean hands thanks to recent education campaigns. He said the improved compliance rates could be driven even higher by more education campaigns and making hand hygiene a key part of all medical training and treatment procedures. “It really needs to become like putting on a seat belt in the car. Automatic,” Prof Grayson said.

Australian Medical Association WA president Dave Mountain said hand hygiene was essential but cleaning gels and soap needed to be readily available. “It's one of those things that in a busy environment it can be forgotten, or it's too hard, so there should be alcohol gels available in every cubicle to make it easy for people to do the right thing,” he said.

In response to the audit, the Royal Australasian College of Surgeons said that from 2013 all student surgeons would have to be certified by Hand Hygiene Australia before beginning their training. The improvements in compliance rates in Australia have also prompted the WHO to make Hand Hygiene Australia and Austin Health one of the world's four centres of excellence for hand hygiene.

The release of the research comes as Federal Health Minister Nicola Roxon pushes States to publish data on how well hospital staff comply with hand-washing guidelines. At today's health ministers' meeting in Brisbane, Ms Roxon will ask for more information about healthcare quality and safety on the hospital comparison website My Hospitals so the public can be informed.

As well as data on hand hygiene compliance, Ms Roxon wants figures on cancer services, cancer surgery waiting times and unplanned readmission rates to be included next year.