Health care workers are becoming less diligent in following hand hygiene guidelines, data compiled by The Press.
In 19 of the 22 establishments that responded to the request for access to information from The Pressthe hand hygiene rate decreased in 2023-2024 compared to the previous year.
At the Integrated University Health and Social Services Centre (CIUSSS) of Montérégie-Est, for example, workers in hospitals and long-term care centres (CHSLDs) in the territory washed their hands properly 86% of the time in 2022-2023, compared to 69% in 2023-2024. At the Integrated Health and Social Services Centre (CISSS) of Outaouais, the hand hygiene compliance rate dropped from 79% in 2022-2023 to 74% in 2023-2024. And at the Royal Victoria Hospital of the McGill University Health Centre (MUHC), there was a drop from 80% to 64%.
The situation worries some patients, including Chantal Hurtubise, whom I met at the Royal Victoria Hospital in July. Suffering from pancreatic cancer, Mme Hurtubise is immunosuppressed and pays attention to hand washing by the nurses and doctors who treat her.
If I have to do tests, it’s something I observe. I don’t always see them wash their hands before, but I see them do it after.
Chantal Hurtubise, pancreatic cancer patient
Michel Gosselin has undergone three operations at the Royal Victoria Hospital without any complications. The slackening of hand hygiene is a particular concern for him as he prepares to undergo a fourth operation. “I’m afraid of catching an infection during my surgery,” he says.
MUHC spokesperson Evelyne Dufresne says the 80 per cent hand hygiene compliance rate achieved at the Royal Victoria Hospital in 2022-23 “represents a peak reached during the COVID-19 pandemic,” when workers were particularly sensitive to infection control issues. “With the return to normal, we are indeed seeing a decline in compliance with the handwashing protocol,” she says, adding that audits are underway to “better understand the situation and improve compliance.”
The Dr Jasmin Villeneuve, a medical advisor to the Biological Risks Department of the Institut national de santé publique du Québec (INSPQ), has also noted a drop in hand hygiene rates in several Quebec hospitals. The cause has not been formally determined by studies. “But most establishments are talking about post-pandemic fatigue,” he says. The presence of new employees who need to be trained in good hand hygiene practices is also a hypothesis put forward.
Four key moments
Health care facilities in the province must conduct annual audits on the hand washing of their employees. Doctors, nurses, nursing assistants, orderlies… All workers are spied on by observers over a given period to see if they are following good practices.
The Dr Villeneuve explains that health care workers should wash their hands at four key times. Before touching a patient or their environment, such as their bed. Before a sterile procedure, such as inserting a catheter or changing a dressing. After being exposed to a patient’s bodily fluid, such as urine. And finally, after leaving the patient.
At Suroît Hospital, in 2023-2024, the hand hygiene compliance rate was only 33% before touching a patient or their environment and 55% after leaving the patient.
“The general management of the CISSS de la Montérégie-Ouest is not satisfied with the most recent results of hand hygiene adherence rates which are decreasing in our facilities,” explains the CISSS Communications Department in a written statement.
“This is why we have intensified the number of observations carried out within our facilities […] in order to be able to have a real-time rate and to target actions well.”
“It seems to me that the hospital is the place where people should pay the most attention to hygiene,” notes Monique Grondin, who came to visit her sister at the Suroît hospital in July.
A crucial gesture
We’ve heard it everywhere during the pandemic: washing your hands is an important step in preventing the transmission of diseases. “It helps reduce the presence of microorganisms on your hands,” says Dr.r Villeneuve: In healthcare settings, some patients have open wounds and are particularly at risk of infection. We must therefore be extra careful, he adds.
Alcohol-based hand rubs are recognized as being as effective as soap and water for washing hands, notes Dr.r Villeneuve. Workers who come into contact with the bacteria C. difficult or with norovirus (responsible in particular for gastroenteritis) must however use soap and water.
In Quebec, the public health authorities’ target for hand hygiene compliance is 80%. Only one of the establishments that responded to The Press achieved this target in 2023-2024, the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal (see other text). In 2022-2023, five establishments had obtained a score above 80%.
However, a handwashing rate of between 60% and 80% can still have a significant effect on transmission, says Dr.r Villeneuve: “Below 60% is not enough,” he said.
In the establishments surveyed by The Pressthree do not reach this 60% threshold in 2023-2024: the CISSS de l’Abitibi-Témiscamingue (50%), the CHU de Québec (55%) and the Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval (IUCPQ) (55%). The Centre hospitalier de l’Université de Montréal (CHUM) also came close to missing this target (61%).
Annie-Claude Lavigne, assistant to the deputy director general responsible for infection prevention and control at the CISSS de l’Abitibi-Témiscamingue, believes that it is “hard to explain” the low rates obtained in her institution. “Studies and literature reviews have shown that several reasons are often cited, such as work overload, lack of time or the layout of equipment in a room,” she says. She adds that sometimes, “it’s not that health care workers don’t wash their hands, but that they don’t do it at the right time.”
At the CHU de Québec, spokesperson Arianne Jobin-Chamberland says her institution has implemented regular training, awareness campaigns and internal audits to ensure that best practices are respected and encouraged. The Saint-Sacrement hospital saw its compliance rate drop from 54% to 39% between 2022-2023 and 2023-2024.
The CHUM is seeing a “widespread phenomenon of relaxation of control measures,” says spokesperson Jessie-Kim Malo. “People are feeling a certain fatigue regarding health measures,” and workers may let their guard down by having the “feeling of a lower risk.” The CHUM is working to strengthen continuing education and is deploying posters throughout the institution on this subject.
Finding the recipe to get health care workers to wash their hands more often is not simple, concedes Dr.r Villeneuve.
We must make people understand the importance of the gesture. For others, and for ourselves. Information campaigns work. But we must always remind people.
The Dr Jasmin Villeneuve, medical advisor to the INSPQ’s Biological Risks Department
Who washes their hands the most?
Some institutions track hand hygiene rates based on workers’ job titles. In Abitibi-Témiscamingue, respiratory therapists (71%) were the most frequent hand washers in 2021-2022, ahead of nurses (57%), nursing assistants (53%), physicians (52%), hygiene and sanitation employees (42%), orderlies (30%) and physiotherapists and occupational therapists (30%). At the CHU de Québec, orderlies were the least frequent hand washers (44%) in 2023-2024.
The Dr Villeneuve specifies that there is no trend showing which type of worker is more likely to be diligent. “It depends mainly on the unit in which you work. We know, for example, that in the emergency room, it is often more difficult. Because the emergency context makes workers forget more often,” he says.
With the collaboration of William Leclerc, The Press