NN&I Article “Hand hygiene compliance improves when patients are empowered to speak up”

Hand hygiene compliance improves when patients are empowered to speak up


Armed with new tools to help them, patients and parents felt empowered to remind health care providers to perform hand hygiene, successfully improving compliance rates, according to a new study published in the August issue of the American Journal of Infection Control. But less than 60% of health care providers surveyed felt that patients should be involved in reminding providers to perform hand hygiene.

Allison Lastinger, MD, of the West Virginia University (WVU) School of Medicine, led a multidisciplinary research team that performed a cross-sectional survey of parents of hospitalized children, adult patients, and primary care physicians at the WVU Medicine J.W. Ruby Memorial Hospital, a 645-bed tertiary care teaching hospital in Morgantown, W.V.

Patients and their families were given one of the five patient empowerment tools (PETs, pictured) upon admission to the hospital and asked to use the tools to remind health care workers to perform hand hygiene.

Allison Lastinger, MD, holds a collection of patient empowerment tools, which are used by patients to remind nurses and doctors to wash their hands when entering their room.

Allison Lastinger, MD, holds a collection of patient empowerment tools, which are used by patients to remind nurses and doctors to wash their hands when entering their room.

Using an anonymous, self-administered questionnaire, the multidisciplinary research team— which included Kayeromi Gomez, PhD, of the WVU School of Public Health, Ellen Manegold, BA, of the WVU Department of Psychology, and Rashida Khakoo, MD, of the WVU School of Medicine — examined their attitudes toward the new patient empowerment tool at the hospital. The parent and patient surveys were distributed from December 2015 to June 2016; the physician survey was distributed in November 2015.

“Patient involvement is increasingly recognized as an important component of hand hygiene improvement strategies,” said Linda Greene, RN, MPS, CIC, FAPIC, 2017 president of the Association for Professionals in Infection Control and Epidemiology. “Organizations must realize that patients and families are an important part of the health care team, and their involvement in hand hygiene campaigns should be encouraged.”

A total of 222 adult patients and parents completed the survey (108 adult patients and 114 parents). Most adult patients (64%) and parents (70%) said the PET made them feel more in control of their care. Most parents (77% for physicians and 81.4 % for nurses) and adult patients (64.8% for physicians and 71.2% for nurses) felt comfortable using the PET to remind health care workers to perform hand hygiene.

Researchers noted, however, that parents were nearly 20% more likely than adult patients to speak up if a physician did not perform hand hygiene. In Ruby Memorial Hospital, hand hygiene rates increased from 48% in 2015 to approximately 75% in 2016 as a result of the hospital’s multipronged initiative to increase handwashing rates among its healthc are providers. “Forty-eight percent is pretty standard,” said lead study author Dr. Lastinger, “so 75 percent is phenomenal.”

Among 89 health care provider responses (29 residents and 60 attending physicians), only 54.9% felt that patients should be involved in reminding providers to perform hand hygiene. Overall, physicians indicated that they would prefer a patient make the request verbally, rather than using the PET to remind them to perform hand hygiene.

Of the physicians who did not support patient involvement, 37%f elt that it was not the patient’s responsibility to remind physicians to perform hand hygiene; 16% felt that it was embarrassing to the doctor; and 13% felt that it would have a negative impact on the patient-physician relationship.

“Based on the results of this study, patient empowerment appears to be an effective strategy to facilitate health care workers’ adherence to hand hygiene, but acceptance of the PET by providers remains a challenge,” said Lastinger. “Barriers to hand hygiene adherence among health care providers should be identified and addressed.”

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