The failure of hospital staff to wash their hands before and after contact with each patient is blamed for most of the 200,000 cases of hospital-acquired infections which are linked with up to 3500 deaths in Australian hospitals each year. 

The Australian Commission on Safety and Quality in Healthcare, which is proposing to launch the handwashing campaign early next year, says a key driver will be the disclosure by each hospital of its in-house infection rates. 

Federal and state health ministers are expected next month to agree on a requirement for all hospitals to collect and disclose the rate of bloodstream infections by drug-resistant golden staph, or methicillin-resistant staphylococcus aureus (MRSA). A recent report by the safety and quality commission presented several case histories in which patients who had contracted infections in hospital underwent repeated surgery, stayed in hospital weeks longer, were disabled or died. 

The elusive nature of the infections was highlighted by a case in which one baby girl's infection spread to eight other babies, who suffered skin sores, abscesses, conjunctivitis and other problems as a result. Only some time later was it found - as a result of bacterial monitoring - that all nine cases were linked. 

More people - between 2000 and 3500 patients - die in Australia each year with infections from hospital-triggered disease in their bloodstream than die on the roads. The commission's chief executive, Professor Chris Baggoley, said publishing infection rates should spur more routine handwashing by doctors and nurses, and that in Britain the rate of hospital infections had been slashed as a result. 

The Federal Government plans to support the approach by tying federal funding more closely to hospital performance under the health financing arrangements to be thrashed out next month. The Health Minister, Nicola Roxon, said: "There are many changes that can be made which are simple, practical, and deliver enormous benefits. For example, the simple act of handwashing can go a long way towards tackling superbugs - but it's just not done enough. "I'll be watching the impact of MRSA infection-rate reporting closely. It could hold useful lessons for the progress of other, similar reforms." 

The World Health Organisation identifies "five moments for hand hygiene" when clinical staff should clean: before contact with a patient; before undertaking a procedure such as inserting an intravenous drip; after exposure to patient body fluid; after patient contact, and after touching a patient's immediate surroundings, such as a bed chart. 

Professor Baggoley said hospitals had made many attempts over the years to coax doctors and nurses to wash their hands at each patient contact, but the attempts had been unco-ordinated and lacked accountability and effective direction from health ministers and hospitals. "The disclosure of infection rates is essential to help drive the hand hygiene campaign," he said. 

An infection control advocate at Canberra Hospital, Professor Peter Collignon, said the lack of concern about handwashing could be attributed to work pressures, a view that infections are "inevitable" and even the practice of wearing gloves, which diverted the focus on protection from the patient to the health worker. 

A crucial element of the hygiene campaign will be making it easier for staff to wash their hands. Dispensers of alcohol-based cleansers could be provided at each bed. Since they not only quell bacteria but are also self-drying, they should remove one of the big excuses of the non-washers: that handwashing takes too much time.  

October 27, 2008