A study by St Luke’s Hospital’s infection control unit has found that hand hygiene among doctors is low and could be a factor in the high incidence of Methicillin-resistant Staphylococcus aureus (MRSA) at the hospital.
Of a total of 898 direct observations by a group of medical students, whose precise assignment was unknown to doctors under surveillance, only 22.7 per cent of doctors were observed washing their hands before contact with patients, and only 33.5 per cent after contact.
Covering 192 doctors – 48 of St Luke’s four-person firms (out of a total of 75) – the study, the first of its kind, was carried out between November 2005 and February 2006. Although consultants of every firm were informed of the study, the actual nature was not disclosed.
The study, published in the Malta Medical Journal, found abysmal levels of handwashing among consultants in obstetrics and gynaecology – only 3.7% in 27 observations complied before and after patient contact. Worse still were senior registrars from the same department, with 0% compliance from eight observations.
Overall, before patient contact compliance ranged from a low 9.9% in obstetrics, to 45.6 per cent in surgical specialties. After patient contact compliance for these same specialties showed rates of 11.3% and 59.5% respectively.
Consultants from general surgery and surgical specialties had the highest rates of compliance, ranging from 35.2% before patient contact, to 63.6% after patient contact.
Average compliance by grade ranged from 16.7% in house officers to 26.6% in senior registrars before contact; and from 29.9% in consultants to 45.5% in registrars after patients contact.
The researchers, Sarah Chetcuti, Maxine Montefort, Elizabeth Scicluna and Michael Borg, said one of the most self-reported reasons for low levels of handwashing was the lack of facilities such as wash-hand basins, soap and water, and alcohol.
“Our results concur with this. A large increase in compliance was observed when facilities were available in the immediate working vicinity. Besides making hand hygiene facilities more available throughout the hospital, these should also be easily accessible and clearly visible as both factors have also been found to increase compliance to hand hygiene practices.”
Hand hygiene, the doctors said, is recognised as “the leading measure” to prevent and reduce MRSA, one of the most feared multidrug-resistant bacteria, which is an important cause of morbidity, mortality and increased costs for hospitalised patients.
The researchers said doctors seemed to be less aware of the risk of hand contamination before patient contact, that is contamination from the environment to a patient upon examination.
But they said it was difficult to determine reasons for the differences in handwashing between the various specialties and grades. “It is unlikely that doctors in different units have varying knowledge and awareness about the importance of hand decontamination.”
The study however warns the number of observations in different specialties and doctors’ grades varied highly, which means it is not possible to establish significant patterns according to grade. The highest number of observations were those of consultants in general medicine (274), where 17.5% and 19.7% were compliant before and after patient contact, respectively.
The method used was a direct observational study to collect data about hand hygiene practices amongst doctors by a 60 trained medical students during clinical assignments. To prevent any bias, the purpose of the study was not disclosed to doctors – they only knew they were being observed for infection control practices.
The students were instructed to “unobtrusively observe” doctors between 9am and 11am, when activity tended to be intensive at the hospital, and record the professional grade of the physicians, specialty, location, activity performed, method used and facilities available. No records of the identities of doctors were kept. The study was also approved by the medical school’s research ethics committee.