Non-compliance with hand hygiene in hospitals getting worse

The latest batch of reports from the State’s health watchdog shows no improvement in hand hygiene standards in hospitals across the country.

Indeed, the problem of non-compliance with correct handwashing procedures appears to be getting worse. Analysis by the Irish Patients’ Association of the Health Information and Quality Authority audits carried out this year shows the hand-washing non-compliance level has risen to 47 per cent, from 45 per cent when the previous batch of reports was published earlier this month. Some hospitals, such as Letterkenny, are scoring poorly on a second round of inspections.

Hiqa looks at far more than handwashing technique when it inspects hospitals, but the results for overall hygiene standards are hardly better.

'Generally unclean'
One of the hospitals in the latest set of reports, the Royal Victoria Eye and Ear in Dublin, is deemed "generally unclean", and there is plenty of evidence of dust, dirt, grime and substandard conditions in the other four hospital reports published yesterday.

While not excusable, these failings can at least be put down to inherited conditions and overcrowded facilities. The Royal Victoria, for example, is housed in a 19th-century building, as are parts of St James's. Many emergency departments exist in a state of near-chaos due to heavy demand and, on occasion, the challenges of coping with patients the worse for wear because of drink or other substances. But how to explain the widespread failure of staff in so many hospitals to perform that most basic of actions, the washing of hands? An earlier report by the health watchdog on Beaumont Hospital revealed that even senior medical staff were failing to adhere to proper procedures to stop the spread of infection during ward rounds, including correct handwashing and the disposal of gowns.

Virtually, all the hospitals audited have the protocols and training courses in place that should ensure standards are met but as Hiqa notes in respect of so many hospitals, these measures are clearly not operationally embedded in the organisations. It is patients who suffer when staff fail to follow correct hygiene procedures and fail to ensure that patients too follow suit. While the levels of MRSA and other hospital-acquired infections have fallen in recent years, they are still far more prevalent in Ireland than in many other countries. Another area of concern is the low level of hospital staff vaccinated against common diseases.

Beaumont responded to its critical report by suggesting that staff may be sanctioned for failing to adhere to hygiene standards. After years of reports and warnings, it may be time for a broader application of the stick rather than the carrot.