Audits show some N.B. hospital staff not washing their hands, wearing masks

Horizon Health Network has told employees they need to do a better job of following rules around "hand hygiene," according to internal memos sent to staff and physicians by the health authority.

A memo in October described how audits performed in Horizon facilities were "revealing a concerning trend" of employees and doctors entering facilities without wearing a mask or sanitizing their hands.

One audit found more than 215 employees who went into an unnamed regional hospital "failed to clean their hands," a November memo said.

"In this particular location, there were 11 hand sanitizer distributors placed within 100 feet of the entrance," the memo said, emphasizing that the requirement for employees and physicians to clean their hands upon entry "is not optional."

There have been more than 300 instances where staff didn't wear a mask when they entered a Horizon facility and more than 1,400 instances where they didn't sanitize their hands, according to compliance audits obtained by CBC News through access to information.

The audits, which took place in October and early November, described the surveillance as a "security blitz" and included data from all of the health authority's major hospitals.

At the Moncton Hospital between Nov. 2 and 8, an audit found 45 staff members didn't wear a mask upon entering the hospital, while 118 staff didn't sanitize their hands in the same scenario.

Majority of employees following rules, Horizon says

At the Dr. Everett Chalmers Hospital in Fredericton, 52 staff members didn't sanitize their hands and 19 didn't wear a mask when they entered the hospital through an ER staff entrance.

And at the Saint John Regional Hospital, 200 staff members were recorded as not sanitizing their hands when they used a staff entrance during the first week of November.

The audits don't provide the total number of people who used those entrances during that time frame, which makes it impossible to determine a percentage of employees who flouted the rules.

No one from Horizon Health Network was made available for an interview about the audits.

In an emailed statement, the health authority said Horizon has more than 12,000 staff members and more than 1,000 physicians, which means "the overwhelming majority of employees are adhering to the guidelines."

"We are continuing to provide ongoing education, motivation and support to our employees, while closely monitoring compliance rates at different intervals through on-site audits," Margaret Melanson, Horizon's vice president of quality and patient-centred care, wrote in an emailed statement. 

"These audits – which include video surveillance and in-person monitoring – will continue as we strive to achieve more consistent results."

'Room for improvement'

Melanson said staff receive regular correspondence about the requirement to wear a mask and clean their hands when they enter a building and there are signs at each entrance.

"While the numbers captured in the audits shows room for improvement, we would note that these guidelines represent a major change in routine for our employees, many of whom are accustomed to sanitizing in other areas of the hospital, such as a locker room, and/or prior to arriving on a unit." 

Union president Norma Robinson was surprised to hear Horizon was conducting the audits. Robinson, the president of CUPE Local 1252, New Brunswick Council of Hospital Unions, described the findings as "worrying" and pointed to exhaustion as one reason why people may slip in following the rules.

"I think that going into the fall, it just needed a little bit more communication from the employers to re-communicate with those employees to make it known that it is mandatory and you must comply with those guidelines," Robinson said.

"Some of it I attribute just to the fact that people become complacent. That's what we cannot do. We cannot become complacent during this pandemic."

The New Brunswick Nurses Union and the New Brunswick Medical Society both declined interview requests to discuss the audits' findings. In an emailed statement, New Brunswick Medical Society president Dr. Jeff Steeves said all New Brunswickers must follow Public Health guidelines to curb the spread of COVID-19.

'The stakes are higher'

Handwashing is even more important in a hospital setting, and not just because of the risk of spreading COVID-19.

A variety of infectious diseases, like the flu and common cold, can spread by surface contact, explained Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa's faculty of health sciences. 

"A doctor will touch a variety of items and people," Deonandan said.

"He or she can be a vector of transmission in and of themselves. So in places where we expect sick people to be, like a hospital, the probability of someone having a kind of infection that can be transmitted this way is higher than, say, your mailman bringing your mail to your door. So the stakes are higher."

Deonandan pointed to fatigue as the likely explanation for why some hospital staff might not follow the rules.

He said there's also a natural human tendency to "avoid rigour."

"It's human nature to just push a little bit more, to get that little bit more at the margins," he said.

But he said the audits' findings could hint at a larger problem of "infection control laxity" in the hospitals.

"Maybe now this additional surveillance rigour is now just revealing a laxity that was always there," Deonandan said.

"We call that detection bias in epidemiology. Now that we're looking for the thing, we see it more."

The rationale behind rule-breaking

In general, most Canadians have followed the rules around COVID-19, but a small minority don't do what they're supposed to do, according to Simon Bacon, a professor of behavioural medicine at Concordia University in Montreal. Bacon is part of an international study that's trying to understand how people across the world have adjusted their behaviour to respond to COVID-19 policies.

With any behaviour change, forgetfulness can play a factor, Bacon said. What's more concerning is people who consistently slip.

"There's a kind of complex process where if we really want a behaviour to stick, we have to ingrain it into our habits," Bacon said.

According to Bacon, there's not a lot of data to back up the idea of fatigue playing a role in behaviour change. But people can feel frustration if they see that people around them aren't following the rules, he said.

Others who consistently don't follow rules may have a rationale for not doing so. For example, Bacon said someone may not sanitize their hands when they go in the hospital because they've just sanitized them in their car.

"If they're consistently not washing their hands on entry into the building rather than just those random slips, there is some cognitive process they've gone through that sort of said, I don't need to do this because," he said.

"It may be a legitimate reason because they feel like they're taking other precautions that are important. But it could also be that they have a misguided perception of what their risk is."

A light at the end of the tunnel

Bacon suggested the health authority should try to learn more about who isn't following the rules and their justification.

Once they know that, the health authority can re-frame its messaging to staff.

"Speaking to them specifically is the only way that you're really going to be able to engage them and get them to do this on a much more consistent basis," Bacon said.

Deonandan suggested the message from the health authority to employees should acknowledge that things have been hard, but with vaccines, things are going to get better.

"I think letting people know this is not an interminable situation, that there's a light at the end of the tunnel, that maybe now is the time to refocus and dig down deep to find some more discipline."