Saskatchewan’s provincial auditor found hand hygiene practices are falling short in her review of hospital acquired infections.
Judy Ferguson examined the Regina General Hospital and Pasqua Hospital over a 12 month period ending Aug, 31, 2018.
Overall, Ferguson found there were generally good hygiene practices in place, but hand hygiene and general cleaning were falling short.
The Ministry of Health target for hand hygiene compliance is 100 per cent, but Ferguson said compliance rates may actually be lower than reported, fluctuating between 80 and 85 per cent.
The 67 units between the hospitals are openly monitored for proper hand-hygiene practices, so employees know they are being watched.
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In May 2017 a blind audit was conducted, so employees were not aware they were being monitored.
The auditor found some units had a 60 to 70 per cent decline in hand hygiene compliance rates compared to the June 2017 direct observation audit.
Ministry of Health guidelines recommend a blind audit in order to provide a better representation of hand-hygiene practices.
Ferguson noted the importance of proper hand-hygiene procedures, reporting this is one of the primary ways to prevent hospital-acquired infections.
According to the report, these infections result in one third of unexpected hospital deaths.
“The Saskatchewan Health Authority (SHA) should rethink its approach to monitoring compliance with hand-hygiene policies to collect more accurate data on its hand-hygiene compliance rates,” Ferguson said.
“Without accurate information on hand-hygiene practices, the authority cannot properly identify which units or hospitals need additional assistance to improve their hand-hygiene compliance.”
The hospital hand-hygiene compliance policy states hands should be sanitized before entering or leaving any facility or unit, before client/client environment contact, after client contact, before aseptic tasks (e.g. sterilizing equipment), and after bodily fluid exposure risk.
Dr. Jessica Minion, medical director of infection control in Regina, said the General and Pasqua Hospitals will be moving toward blind hand-hygiene audits to get a better picture of compliance.
“It’s not dissimilar to speed traps. If you advertise that there’s a speed trap you’re going by most people slow down, so if people know that they’re being watched they will improve their performance. It’s what they do when we’re not looking that we’re most going to focus on now,” Minion said.
In addition to this shift they will be enacting focused accountability in units where there are bigger issues with hand-hygiene.
Minion added that this is an issue across the healthcare sector and not exclusive to Regina.
“They do know that hand hygiene is important for our patients to remain safe in hospitals, but there is so much that is put on our front-line staff that it does sometimes get missed,” Minion said.
“We’re not asking them to wash their hands once a day. We’re asking them to wash their hands dozens, if not hundreds of times every shift. When you see maybe an 80 per cent compliance, that means maybe they only washed their hands 80 times out of the 100 times we wanted them to.”
The audit found new employees receive about an hour of hand-hygiene training when they start their jobs, and further training is “ad hoc.”
“Up to 70 per cent of hospital-acquired infections are preventable; hospital acquired infections can unnecessarily extend a patient’s hospital stay, and lead to increased complications and costs,” Ferguson said.
This issue has been the subject of past audits in the former Prairie North and Sunrise health regions. Ferguson said that both regions saw positive change in hand-hygiene after the respective reports.
Surgical biopsies
Ferguson also found labs in Regina and Saskatoon took considerably longer than good practice to analyze surgical biopsies.
Surgical biopsies are tissues removed from a patient to help provide a diagnosis for a variety of health problems, including cancer.
In 2017-18 the average wait for a surgical biopsy report out of Saskatoon was 12.1 days, and 18.7 days in Regina.
Ferguson said good practices suggest routine biopsies take five business days, with more complex biopsies taking six to 15 business days.
She also found shortcomings in the in the tracking process, noting neither city’s labs tracked biopsies through the entire process.
Saskatoon plans to introduce better tracking through a new IT system expected to be in place this month. The Regina lab did not have similar plans.
“A formal assessment of the surgical biopsy process and IT tracking system could help the SHA to identify factors affecting delays in patient diagnosis,” Ferguson said.
Corey Miller, the vice-president of provincial programs with the SHA, said turning around biopsies in five days will take work.”That would be great target for us but we’re not there yet for sure,” he said.
“The labs now have a visual graph of the backlog which has been well-received,” Miller added
“They don’t just see stacks of specimens and slides. They actually can look at the chart and see a graph that shows we’re trending down or we’re trending up and we can reallocate our resources with the team.”
Physicians are also able to prioritize biopsies if they feel it’s urgent, he said.
The five labs are located between Saskatoon and Regina with single labs in Prince Albert, North Battleford and Moose Jaw.
Saskatoon and Regina labs analysed over 150,000 specimens from surgical biopsies last year, or about 45,000 cases. The Saskatoon lab has 58.5 full-time positions while Regina has 40.5 positions.
Miller said there is a shortage of pathologists in the province and the authority is recruiting. He said up to five more pathologists are needed to handle the workload.
The auditor found neither Saskatoon or Regina tracked biopsy specimens through the entire process. Miller said a pilot project using barcodes will be in place this month and could be extended to Regina.
Opposition NDP Leader Ryan Meili, who is also a physician, said the issue was first raised in 2015. He said other colleagues have said waiting for a diagnosis is a real concern.
“It’s a pretty important period that should be shortened as much as safely possible,” he said.
With files from The Canadian Press