Ariadne Massa
Just one in 10 medical staff wash their hands
Poor hand hygiene leads to resilient infections
Just one in 10 doctors and nurses at Mater Dei Hospital wash their hands before treating or examining patients - exposing poor hand hygiene that increases the spread of potentially deadly infections.
With 91 per cent failing to wash their hands, hygiene habits have barely improved since the migration from St Luke's Hospital to Mater Dei where wash-hand basins and alcohol rub stations increased six-fold to 30 in each ward.
The figures are quite disheartening for Michael Borg, chairman of the Infection Control Committee which carried out the 2008 Epidemiological Report seen by The Sunday Times, issued recently to mark European Antibiotic Awareness Day.
Dr Borg said it was essential for healthcare workers to wash their hands before and after touching a patient - especially when inserting a catheter or regulating the intravenous drip; after touching the environment in the hospital ward, such as beds and equipment; and after handling body fluids.
However, just 16 per cent of doctors follow these guidelines. Nurses fare a little better, but just under a quarter (23.5 per cent) comply with hand hygiene requirements.
Doctors and nurses are not overly concerned about their own health it seems, with just 22.7 per cent cleansing their hands after coming into contact with body fluids.
Dr Borg had anticipated better infection control compliance once the hospital migrated to a new building. However, he said improved facilities on their own were not enough - the staff's mentality had to make the same shift forward.
A hand hygiene campaign to tackle this problem kicked off last year, but attitudes took a long time to change. In the meantime, Dr Borg encouraged patients to be vigilant and remind healthcare workers to wash their hands or use alcohol rub.
Poor hand hygiene leads to the cross-transmission of resilient infections, such as the antibiotic-resistant superbug MRSA that lurks in most hospitals, leading to complications and even death.
MRSA is a type of bacteria commonly found on the skin and in the noses of healthy people. Although it is usually harmless, it may occasionally get into the body through breaks in the skin such as abrasions, cuts, wounds, surgical incisions or catheters, and cause infection.
Hospital patients, as a result of their sometimes weakened immune systems and intravenous lines, are particularly vulnerable to these resistant strains. This makes hand hygiene even more important.
Migrating to a new hospital did little to eliminate or reduce the presence of the lurking superbug - Mater Dei has an average of 25 MRSA cases a month, registering a small improvement over St Luke's monthly average of 28. However, the island still has one of the worst rates in Europe.
"We have come as far as we can get in terms of infrastructural improvements - among the best in Europe - to reduce the spread of MRSA. It is now up to the staff to change their ways," Dr Borg said.
Ten per cent or more of patients entering any hospital contract an MRSA infection, or another hospital bug unless good infection control practices are in place.
However, Dr Borg said he was pleased to note a significant drop in the number of the more serious MRSA blood infections which went down to an average of 1.9 cases a month at Mater Dei, compared with 3.7 cases at St Luke's.
The Intensive Therapy Unit was also a success story, he said. A collaborative programme with ITU consultants and nurses had led to a drastic decrease in MRSA and other multi-drug resistant organisms.
"If we can achieve a hand hygiene compliance rate of at least 60 per cent, we would halve the current rates of MRSA in hospital; it's not rocket science," Dr Borg said.
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Dr Kadiyali M Srivatsa
Dec 7th 2009, 10:23
I used to promote good hand washing technique and observing drying time more important to prevent spreading infections in our hospitals.
Recent publications claiming colonisation of resistant bacteria in water, soil and ethanol/ alcohol (antibiotics are used in fermentation technique). Excessive hand washing is said to produce dermatitis in the hands that carry more antibiotic resistant bacteria. This makes me vary about jumping into the bandwagon that promote hand washing and start blaming staff who don't wash their hands. We must look carefully at the new evidence and critically analyse than jump-in blindly and start implementing changes that do not work.
The bacteria are also said to change their genetic makeup faster than known before. This makes it more likely that we know less about the bacteria, virus and fungi than we thought we knew.
M. Mizzi
Dec 7th 2009, 10:19
When I was a child I remember that when our family doctor came for a home visit, he always went to the bathroom to wash his hands before leaving. I never see this happening nowadays.
C.ZARB
Dec 7th 2009, 09:41
Mr Zammit, I guess you do notice the difference between a repetitive job and curing people don't you?
I don't work in the health sector (No Im neither a doctor nor a nurse) yet I've learnt long ago that unless you don't provide a system with adequate staff (which is usually attracted by adequate salaries), then its very difficult that it will work efficiently. Unfortunately in Malta we tend to put resources to other priorities. Considering how Enemalta, MEPA, The Vat department, Mater Dei, Education and the Road System, then maybe it makes sense to increase the MPs salaries rather then putting more resources in the Health system.
harja potere
Dec 7th 2009, 04:07
you forget that they use their mobiles in the middle of treatment
C.ZARB
Dec 6th 2009, 20:41
BTW I don't work in the health sector. I work in management (not health related), although I have conducted some research regarding various health sectors both locally and abroad.
Anyway I wouldn't call lazy someone who works a 70 hours week under stressful conditions where 1 mistake can cost someone's life. There again if you feel capable to do a better job then the 'we know best how to do our job' people, then please do not hesitate to become a doctor/nurse. We need people like you.
C.ZARB
Dec 6th 2009, 20:26
Don’t you think that there is a\ difference between a repetitive work that require little brains (ex putting heads on one of the pupi tal-playmobile) and curing people?
Lack of staff is the catalyst (apart from bad management which any politician lead hospital would have) to why our health sector is breaking down. Many people just love to mention the British Health sector but can you please compare their patients to doctors/nurses quota with ours? Not to forget their salaries with our doctors/nurses ones? You can’t expect that a nurse who has to take care of the patients of an entire ward to be able to give the same quality service of one who has just 10 patients under her care wouldn’t you?
Now if you feel that chucking doctors/nurses out is the solution (rather then search the root of the problem and solve it) then I hope that the government heed to your advice. Believe me the Maltese doctors/nurses will easily find quality job somewhere else. I wonder whether the government would be able to replace them so easily and with such quality staff considering the poor salary/conditions we give to our health staff.
Peter Zammit
Dec 6th 2009, 19:01
@C. ZARB
I am sorry but the lack of staff is the usual excuse we hear for every hospital ill. Do you think factories have an abundance of people falling over each other. Yet they work to a high standard because their job depends on it. I recently visited a relative at Mater Dei - every room has a sink no more than a few paces from each patient. There was even alcohol rub at the entrance. I put some on as I was going in because of the swine flu thing and it dried by the time I walked a few metres. Why don't you nurses and doctors do the same? It will only take you one or two extra seconds. Is that too much to ask? There were at least three posters I saw that encouraged hand washing so it's not because you don't know. Do you care about your patients?
Your comments are just excuses to hide as J Oatman said, laziness, and a bit of the 'we know best how to do our job' attitude. Would you accept to eat at a restaurant where chefs only washed their hands 10% of the times they should?
C.ZARB
Dec 6th 2009, 18:04
@ J Attard
And with whom would you replace them with? The politician of your choice maybe? The problem goes beyond what common people can see. We have a hospital which is heavily understaffed and which staff is heavily underpaid and working under ridiculous conditions. Under such circumstances it difficult to maintain a high level of hand hygiene. Maybe it wouldn't be a bad idea to start paying doctors/nurses etc at the same level of politicians, considering that the former actually do something good for our society.
J Oatmon
Dec 6th 2009, 17:40
So is this just laziness, and a bit of the 'we know best how to do our job' attitude, or a lack of repeated instruction to doctors and nursing staff.
As J Attard noted, repeat 'unhygenic offenders' have no excuse, and they should be warned then, if they do not comply with requirements, their employment terminated.
The overiding principle is the patient comes first, not the staff's bad habits or their right to flout instructions, or some sort of union interference.
Michel Bencini
Dec 6th 2009, 17:29
How about installing hand sanitizers/dispensros in public spaces and medical clinics and hospitals not to mention that all health personnel be provided with disposable gloves when examining patients? That would definitely go a long way to mitigate transmission of infections and most forms of virus. It is just a matter of getting used to. It will save lives and major medical expenditure in the long run.
J Attard
Dec 6th 2009, 16:23
@Ray Buhagiar
Your same literature search would tell you that in the UK, staff actually risk dismissal for persistent neglect of hand washing. And they are reporting 90% success rates.
Your comments make me assume that you are a nurse or doctor if you even try to justify this!! Shame!
Ray Buhagiar
Dec 6th 2009, 15:14
Nothing New. A literature search on hand hygiene would bring the same findings everywhere in the world.
Eric Soames
Dec 6th 2009, 15:11
Patients should also be encouraged to speak up, if they're conscious, and remind health workers to wash their hands.
D.Bonello
Dec 6th 2009, 14:37
This is alarming news. Only in third world countries this happens. Patients should start telling them to wash thier hands before they get touched. We as a society need to educate them.
Joe |Morana
Dec 6th 2009, 11:14
Regrettably, I have repeatedly experienced poor medical health hygene practices in polyclinics (e.g. Floriana and Gzira Health Centres ). I got the impression that some nursing staff at these polyclinics take precautionary measures only for their health and safety (use of rubber gloves) and to a much lesser degree that of patients (e.g no washing of hands etc) . On reporting such instances to the authorities, it transpires that "the patient is never right", as it is the patient's word (complaint) vs that of the nurnsing staff (denial). How is that for a reasuring public health care paid for by taxpayers money?Shame.