There has been so much focus on improving healthcare provider hand hygiene over the past decade that it might be tempting to overlook the importance of patient/client hand hygiene in patient safety. Indeed most of the tools currently available on healthcare related hand hygiene tend to focus on staff—if patients and visitors are mentioned, they tend to be an afterthought. Yet we know that certain organisms such as C. difficile, noroviruses, vancomycin-resistant enterococci are acquired via the fecal-oral route, hence it is plain common sense to focus on patient hand hygiene in addition to other control strategies.
This issue is especially important as we raise awareness during the Canadian Patient Safety Week to enlist healthcare facilities across Canada to improve patient safety and quality and help spread the message to “Ask. Listen.Talk.”
Important Message of Hand Hygiene
In our experience, most patients are familiar with the important role washing their hands plays in keeping them safe but are unable to accomplish this while in the hospital. We have heard patients say that they prefer soap and water over alcohol based hand rub (ABHR), do not always have access to hand hygiene products at the bedside and some have even questioned whether they are allowed to use the ABHR mounted on the walls, as they fear this is only for healthcare providers. Finally some patients have also told us that they know how to wash their hands and don’t need to be reminded—something that sounds eerily familiar to what we often hear from healthcare providers.
A look at the existing medical literature suggests that the area of patient hand hygiene has not been well studied. As yet unpublished research from our own program indicates that patients do not clean their hands frequently during their hospital stay when using the washroom, before meals, and on entering and exiting their room. While there has been great human factors analysis work for healthcare provider hand hygiene, very little exists that focuses on the patient and their visitors. Clearly much work needs to be done.
Like many infection prevention and control programs, likely patient education is a good place to start. How many of us provide our new admissions with information on why hand hygiene is important for them to perform and how they can do it? Is the education we provide learner-centered? We should involve patients and their visitors in the development of such programs to ensure that we are providing meaningful and understandable information. We should also be auditing our education programs to ensure that they are actually achieving what they set out to do.
Human factors analysis would also help: do patients have ready access to ABHR and/or sinks? Are they provided with the means to clean their hands before eating if they are bed-ridden? The parallels with healthcare provider hand hygiene are obvious: education is part of the solution but we also need to make it easy for patients to comply. Eventually we need to arrive at a point where patient hand hygiene is simply the norm.
In taking an approach of patients as partners in their care we believe we will see great improvement in patient hand hygiene this decade just as we are starting to see with healthcare provider hand hygiene. This along with strategies such as improving environmental cleaning, healthcare setting design and others will help move us closer towards eliminating healthcare associated infections.
For more information on the Canadian Patient Safety Initiative go to http://www.patientsafetyinstitute.ca/. And for information related to effective hand hygiene, visit www.gojo.com/coldandflu.