INFECTION PREVENTION AND CONTROL
an ambitious target of halving the inappropriate prescription of antibiotics in humans by 2021. Family doctors have already made good progress with over 2.6 million fewer prescriptions in 2015-16. This is all good news, but a lot more needs to be done globally. Resistance has increasingly become a problem in recent years because the pace at which we are discovering new antibiotics has slowed drastically, while antibiotic use around the world is rising.
My dad was only one of 50,000 lives – across Europe and the US alone – that antimicrobial-resistant infections currently claim every year. But isn’t it time we implemented change rather than just addressing the threat of hospital-acquired infections?
The threat of healthcare-associated infections (HCAIs)
The World Health Organization estimates that 50% to 70% of HCAIs are transmitted by hands, and that more than half are preventable through good hand hygiene. Yet, in the UK, a patient admitted into hospital has a 6.4% chance of contracting a hospital infection. In total, more than 300,000 patients are affected by hospital infections in the UK every year. There are 5,000 patients who, like my father, die from a hospital infection every year. That is 5,000 too many.
Despite the high number of patients who contract infections whilst being treated at hospitals, it is extremely difficult to pinpoint the moment when the contraction occurred. In my father’s case, I witnessed many missed opportunities for hand washing. However, by collating accurate data on
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hand hygiene compliance, it may be possible to spot patterns of behaviour amongst staff that could lead to preventative action. However, the current system of hand hygiene monitoring in hospitals, known as “direct observation”, allows poor hand hygiene practice to spread and can put patients’ lives at risk. It needs updating and there are better monitoring systems available.
The flaws of direct observation
Firstly, many of the nurses currently performing direct observation audits on colleagues are not trained to perform such tasks. That means that audits are often incomplete, inconsistent and ineffective. Secondly, direct observation artificially
inflates reported compliance, due to ‘The Hawthorne Effect’. Naturally, staff wash their hands more frequently when they know they are being monitored. I was astounded at the research that Deb Group showed me during my Handz campaign. They conducted peer- reviewed research that shows that the true levels of hand hygiene compliance are in fact between 18% and 40%, rather than the 90% to 100% typically recorded in UK hospitals. That means that direct observation as a means of monitoring artificially inflates reported compliance by as much as 50%. We cannot begin to address the problems of poor hand hygiene when our hand hygiene audits report figures of 90% to 100% compliance. To increase hand hygiene standards in our hospitals, basic behavioural psychology dictates that we need accurate and timely feedback to drive behavioural changes. Yet direct observation audits are often only completed quarterly or, at best, monthly. However, if healthcare operators can see first-hand through precise, quantifiable data that their staff are not washing their hands at the rate required to achieve compliance, then they can take action to communicate this to the healthcare workers. From there, these highly-trained professionals can re-evaluate their hand hygiene practices in every action they take before, during and after treating patients. With electronic data readily available, it provides an accurate picture of what is being done to prevent the contraction and spread of infections – not only for staff, but for patients and their relatives too, empowering them with the knowledge that the standard of care is constantly being reviewed and improved.
SEPTEMBER 2018
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