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New research reveals poor hospital hand hygiene is spreading MRSA

24 July 2006

Unwashed hands in the UK’s hospitals are contributing to the spread of meticillin-resistant Staphylococcus aureus (MRSA) and will continue unless healthcare professionals are taught to assess risk, reveals new research from the University of Hertfordshire and the Institute for Employment Studies (IES).

Ensuring health professionals follow simple rules of hygiene like hand washing is key to stopping bacteria spreading. But observed practice shows very poor rates of adherence to guidelines and reveals that staff fail to take account of risk, even with patients with MRSA.

The findings published in The Journal of Hospital Infection showed that 38 per cent of the research sample of health professionals failed to wash their hands after contact with MRSA patients, while 25 per cent failed to wash their hands after contact with faeces and 38 per cent failed to wash their hands after contact with blood.

The study observed healthcare professionals on hospital wards and compared their hand hygiene behaviour with self-reports of their actions, taking particular note of practice when working with patients infected or colonised with MRSA.

Hand hygiene poor

Hand hygiene among the healthcare professionals involved in the study was poor despite the knowledge that they were being observed. Also, self-reported behaviour was totally unrelated to actual observations.

Observed practice was not rational. For example, hands were only cleaned on 14 per cent of occasions before wound care, when the aim should be to prevent the patient from developing an infection. On average only 12 per cent washed their hands both before and after treatment of an MRSA patient, putting other patients and him/herself at high risk of cross infection.

The research examined the implications of inadequate hand hygiene in hospitals, its role in the spread of infection, such as MRSA, and the effectiveness of practical demonstrations and hand hygiene posters in carrying the message.

Dr Linda Miller, Senior Research Fellow at the Institute of Employment Studies (IES), and a supervisor on the project said:

‘The research clearly shows that hospital staff do not pay sufficient attention to hand hygiene despite increased awareness of the endemic problem of MRSA in our hospitals. Attention to improving hand hygiene is a priority if hospital infection rates are to be reduced.’

Dr Elizabeth Jenner, Principal Lecturer in Infection Control in the University’s School of Nursing and Midwifery, said:

‘Inadequate hand hygiene practice contributes to the prevalence of hospital-acquired infection, which is costing the NHS nearly £1 billion a year. MRSA is now endemic in most of our hospital and England now has the worst MRSA bacteraemia rate in Europe.’

Professor Ben Fletcher, Head of the University of Hertfordshire’s School of Psychology, added:

‘What is most worrying here is that healthcare professionals say one thing and they do another. There is no link between what they say and what they do.

‘If we adopt a culture where we urge healthcare workers to treat everyone as if they are infected, then they stop risk assessing. They can’t wash their hands all the time, so we need to teach them how to risk assess.’

Hand hygiene in 71 healthcare professionals (doctors, qualified nurses, therapists and healthcare assistants) was observed on hospital wards for a total of 132 hours, encompassing 1,284 hand hygiene opportunities. Each of those involved also completed a questionnaire based on the Theory of Planned Behaviour (TPB), to explore hand hygiene practice.

MRSA is resistant to antibiotic treatment.

Further information

For further information contact: Jenny Murray, Communications Management, Tel: ++44 (0) 1727 733889.

The paper, Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals is available at www.sciencedirect.com

The authors have developed a Dynamic Assessment Strategy for Hand Hygiene (DASHH), which offer one way of changing poor practice. It does this by teaching carers to consider hand hygiene as before and after care as separate activities requiring separate risk assessments. The strategy provides a simple mental map to make the quick informed decisions required when on a busy ward.