Hand hygiene in New Zealand hospitals has majorly improved in the past eight years but  doctors have fallen back to being the least compliant of the health professions.

May 5 is World Hand Hygiene Day with the World Health Organization (WHO) choosing  “It’s in your hands –  prevent sepsis in health care” as this year’s theme. WHO is calling on health facilities and health professionals to help prevent health-care associated sepsis through hand hygiene and infection prevention and control action.

The latest Hand Hygiene New Zealand (HHNZ) report of how well district health board health professionals are complying with the WHO five moments of hand hygiene when with patients (see ‘moments’ below), shows that across the board all health professionals have improved since auditing began in 2012.

But medical practitioners and student doctors currently lag behind other health care workers, according to the report.

Phlebotomy technicians – who take blood samples – have consistently been the most successful in meeting all five moments of hand hygiene across the eight health care worker groups monitored by the regular audits for the Health Quality & Safety Commission’s HHNZ campaign.  Phlebotomists compliance has increased from 70 per cent in 2012 to more than 90 per cent in 2018.

At the bottom of the list since 2012 has been student doctors who sat at 42.6 per cent in 2012 but did jump up to 82 per cent compliance  for several years before slumping to last place with 67.2 per cent in the latest report.

Medical practitioners back in 2012 were 55 per cent compliant but quickly responded to the hand hygiene campaign and were third in the ranks behind phlebotomists and allied health workers in 2015 and 2016 with 83 per cent compliance.  But in the past four audits they have slipped back to 7th out of the eight health care worker groups with 77.5 per cent.

Nurses and midwives – who often have infection prevention and control roles in DHBs – started off as second best in 2012 with 65 per cent compliance but actually went backwards and then plateaued for several years but for the past four audits they have consistently had between 87 and 88 per cent compliance.

Allied health care workers in 2014 were the quickest of the health workers to reach and exceed 80 per cent compliance and have been consistently above 80 per cent ever since with the latest audit report having them at 86.4 per cent compliance.

Nursing and midwifery students and health care assistants have also had been 80 and 84 per cent compliance for the past four audits.

The report – released in the lead-up to World Hand Hygiene Day – also shows that in the audit round to March 31 2018 that 14 DHBs met the 80 per cent target and national compliance now sits at 85.3 per cent – up from just over 60 per cent when auditing began in 2012.

Other positive trends included improvements in hand hygiene in areas where patients are at high risk of infection – including emergency departments – and improved compliance when people are wearing gloves.

Sepsis trends

Dr Sally Roberts, the clinical lead of the Health Quality & Safety Commission, says the number of children being admitted to New Zealand paediatric intensive care units with severe infections, including sepsis, has increased over the last 10 years.  About four per cent of these children die.  She said the international evidence was clear that improved hand hygiene practices help reduce health care-associated infections.

“Hand hygiene is the simplest, most effective way to prevent the spread of health care-associated infections, so it’s important that everyone working in the health sector practices good hand hygiene. Clean hands save lives,” said Roberts.

 

Roberts says the biggest increased in children admitted to paediatric ICU were babies aged less than 28 days because they were too young to be vaccinated against vaccine-preventable diseases.

“One reason for the increase in severe infections in older children is an increase in the number of invasive skin and soft tissue infections.”

She said advances in paediatric cancers and haematological malignancies were also leading to more severe immunosuppression and therefore increased infection risk, and there are also more children with co-morbidities.’

Dr Roberts said about 10 percent of adults admitted to intensive care units have severe sepsis.

“For the majority, sepsis developed before they were admitted to hospital. While the rate of death from severe sepsis or septic shock in adults has decreased over the last couple of decades, it’s still around 4.6 percent.”

Dr Roberts said with sepsis it was not uncommon for someone to seem completely well one day, and be very sick with sepsis, or even septic shock, 48 hours later. “The risk of death is significant if sepsis leads to septic shock, with approximately 40 percent of septic shock patients dying, even with treatment.”

One Waikato study found 10 percent of patients admitted to hospital because of infection had sepsis. Around 17 percent of these patients were admitted to intensive care units and nearly 34 percent of them died.

See more at: www.handhygiene.org.nz

 The WHO Five Moments of Hand Hygiene

  • Before touching a patient
  • Before a procedure
  • After a procedure or body fluid exposure risk
  • After touching a patient
  • After touching a patient’s surroundings

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