Use of a patient empowerment tool for hand hygiene

Hand hygiene knowledge and practices of family caregivers in inpatient pediatrics

Family caregivers are essential inpatient pediatric care partners, yet their handwashing knowledge and compliance are rarely studied. Through hand hygiene audits and self-administered questionnaires, we observed 9% compliance, significantly lower than self-reported practice. We suggest interventions to improve caregiver handwashing behaviors to decrease infection transmission risk to hospitalized children.

Supporting patients and their carers to participate in infection prevention and control activities: The views of patients, family members, and hospital staff from Bangladesh, Indonesia, and South Korea

BACKGROUND

Hand hygiene reminders for healthcare workers (HCWs) are commonly used to empower patients. However, this approach overlooks the role of family carers in delivering direct contact care in Asian countries. Limited knowledge exists regarding empowerment strategies for patients and their family carers in infection prevention and control (IPC) recommendations. This study aimed to provide a comprehensive exploration of IPC empowerment within the context of family involvement in care provision across Bangladesh, Indonesia, and South Korea.

METHODS

In-depth interviews were conducted in 5 tertiary-level hospitals in Bangladesh, Indonesia, and South Korea. A total of 64 participants were interviewed through 57 interviews, including 6 group interviews, comprising 2 groups: (1) patients and their family and private carers; and (2) HCWs.

RESULTS

The study identified barriers to engaging patients and family carers in IPC measures. These included concerns about the patient-HCW hierarchical relationship, lack of knowledge about healthcare-associated infection, IPC, and patient zone, perceptions of IPC as a barrier to family connections, and disempowerment of patients in IPC due to family bonds.

CONCLUSIONS

This study provides diverse perspectives on IPC empowerment, revealing challenges faced by patients, family carers, and HCWs. The interlaced relationship established by social norms of family carer provision hinders the empowerment of family carers. Acknowledging the cultural influence on health care arrangements and its implication for IPC empowerment is crucial in mitigating these barriers.

Determinants of hygiene practices among mothers seeking delivery services from healthcare facilities in the Kampala metropolitan area, Uganda

Our study aimed at assessing the determinants of hand hygiene and utilisation of bathing facilities in healthcare facilities (HCFs) in the greater Kampala metropolitan area, Uganda. Results indicate that 19.9% of the respondents wished to wash hands and failed while 39.3% faced challenges related to bathing. Failure to wash hands was associated with received information on hand washing (APR = 1.14, 95% CI: 1.06-1.24), using piped water (APR = 0.88, 95%CI: 0.78-0.98) or a well as the main water source at the HCF (APR = 1.21,95% CI: 1.03-1.42). Experiencing challenges of bathing was associated with accessing healthcare services at a hospital (APR = 0.89, 95% CI 0.81-0.97) and using public HCF (APR = 1.10, 95% CI: 1.01-1.120). There is urgent need to improve hand hygiene and bathing facilities though providing reliable water and soap.

"Did you wash your hands?": a prospective study of patient empowerment to prompt hand washing by healthcare providers

Background

Hand hygiene is paramount in preventing the spread of healthcare-associated infections especially during disease epidemics. Compliance rates with hand hygiene policies remain below 50% internationally and may be lower in the outpatient care setting. This study assessed the impact of the patient empowerment model on hand hygiene compliance among healthcare providers.

Methods

From October 2016 to May 2017, patients from a large ambulatory oncology centre were prospectively enrolled. Patients were instructed to observe healthcare providers for hand hygiene compliance and to remind healthcare providers where it was not observed during at least three consecutive encounters. Healthcare provider reactions to this intervention were rated by patients. Patients' hand hygiene knowledge and beliefs were objectively elicited pre and post-study.

Results

Thirty patients with a median age of 52 years (range 5-91) completed the study for a total of 190 healthcare provider encounters. When initial hand hygiene was not observed, patients offered a reminder in 71 (37.4%) encounters, did not offer a reminder in 73 (38.4%) encounters and forgot to offer a reminder in 24 (14.2%) encounters. Patients perceived positive or neutral reactions in 76.8% of encounters and negative or surprised reactions in 23.2% of encounters. Healthcare provider compliance improved from 11.6% to 48.9% with intervention. Patient hand hygiene knowledge improved by 16% following the study.

Conclusions

Patient-empowered hand hygiene may be a useful adjunct for improving hand hygiene compliance among healthcare providers and improving patient hand hygiene knowledge, although it may confer an emotional burden on patients.

Evaluating the effect of automated hand hygiene technology on compliance and C. difficile rates in a long-term acute care hospital

BACKGROUND

Compliance with hand hygiene (HH) standards is a critical component to reducing the prevalence of Health Care Acquired Infections (HAIs). The use of HH technologies is increasing and studies examining the success of these technologies on HH compliance and HAIs are important to inform standards of care. COVID-19 has emphasized compliance HH standards.

METHODS

This study evaluated HH compliance and Clostridium difficile (C difficile) rates following implementation of an HH technology at a long-term acute care hospital. The HH technology required nursing and other staff with direct patient contact to wear a "badge" that measured alcohol concentration on a health care worker's hands or time washing hands at designated sinks upon exit/entry of patient rooms. No changes were made to environmental cleaning or antibiotic stewardship standards. Compliance and infection rates were compared 12 months pre-post implementation during 2017-2019.

RESULTS

There was an increase in HH compliance (89.82%-97.10%, P< .001)) and a reduction in the incidence of C. difficile (9.541-3.720, P= .0032).

CONCLUSION

The HH technology significantly and quickly increased HH compliance and reduced rates of C difficile. The technology provided ancillary benefits, including data tracing of all patient and staff contacts and cross-contamination events.

TRANSLATION AND TRANSCULTURAL ADAPTATION OF THE PATIENT MEASURE OF SAFETY (PMOS) QUESTIONNAIRE TO BRAZILIAN PORTUGUESE

ABSTRACT Objective to translate and culturally adapt the Patient Measure of Safety questionnaire to Brazilian Portuguese. Method a transcultural adaptation study conducted in six stages: translation, synthesis, back-translation, review by experts committee, pre-test, and presentation of the documentation of the entire process to the authors of the instrument. Results in the initial translation and cultural adaptation stage, two versions of the questionnaire were generated. The divergences between both versions and other suggestions were discussed, and the decisions were made by consensus, thus creating a single version. In the back-translation stage, there were no significant differences between the versions and the original instrument. The assessment of the semantic, idiomatic, cultural and conceptual equivalences of the Patient Measure of Safety items was performed by a committee of experts from different Brazilian regions. The results of the content validity index were above 0.9 for most of the items. The pre-test was conducted with 30 patients. The mean time for the application of the questionnaire was 31.9 minutes. In relation to the understanding of the items by the patients, a regular or poor interpretation was identified only for 6 of the 44 items, which were modified. Conclusion the “Questionário de Avaliação da Segurança pelo Paciente”, name given to the translated and transculturally adapted version, resulted from a thoughtful process, presenting consistency in the equivalence of the translation and constituting an applicable instrument understood by the target population.

Human Errors in Automated Office Blood Pressure Measurement: Still Room for Improvement

In this review of the literature and commentary, we examine the literature on automated blood pressure (BP) measurements in the office and clinic. Our purpose is to revisit issues as to the pros and cons of automated BP measurement published in Hypertension in June 2020 and to identify areas needing additional research. Despite initial reservations about automated BP, it is here to stay. A number of experts suggest that human error will be reduced when we move from the more complex skills required by aneroid sphygmomanometer measurement to the fewer skills and steps required by automated BP measurement. Our review indicates there is still need for reduction in errors in automated BP assessment, for example, retraining programs and monitoring of assessment procedures. We need more research on the following questions: (1) which classes of health care providers are least likely to measure BP accurately, usually by ignoring necessary steps; (2) how accurate is BP assessment by affiliated health care providers for example the dental office, the optometrist; and (3) why do some dedicated and well-informed health care professionals fail to follow simple directions for automated BP measurement? We offer additional solutions for improving automated BP assessment in the office and clinic.

Active Integration of Patients into Infection Control, as perceived by Health Care Professionals: Results of the AHOI Pilot Study

Objective

Medical professionals have a key role in active patient involvement in infection control and prevention (ICP). ICP of hospital-associated infections is critical for patient safety and requires targeted integration of patients and their relatives. The possibilities of proper involvement are identified, tested and realized in the innovative AHOI project. Its acronym stands for Activation, Help, Open communication and Infection prevention. The project is based on the three dimensions acceptance, empowerment and adherence. The results presented here are from a health-care professional (HCP) focused part of a pilot study to implement AHOI intervention. This section aimed at the HCPs’ evaluation of the intervention material, their perception and acceptance of the adherence and empowerment of patients, as well as the perception of their and colleagues’ own behavior.

Methods

The cross-sectional survey was conducted with a questionnaire at two surgical wards of a third-level hospital for 14 weeks. All HCPs with contact to patients were entitled to voluntarily participate in the study. AHOI instruments such as visual reminder, videos for patients and the AHOI-box were implemented on the wards. Additionally, the ward personnel received a psychological and practical train-the-trainer curriculum.

Results

Sixty-nine questionnaires were handed out and 29 returns were analyzed. The results show a strong identification and acceptance of HCPs with their role in the AHOI project. No additional workload was perceived by implementing AHOI. Teaching of medical professionals and information materials are seen as good supports. HCPs are empowering hygienic behavior in patients and colleagues. HCPs observed increasing adherence of patients.

Conclusion

HCPs positively perceived acceptance, support and identification with the ideas of the AHOI project. Therefore, since HCPs are key for patients and their relatives, AHOI intervention seems to be a feasible instrument and aid in implementing national and international recommendations for hygienic behavior.

Discourse on hygiene between hospitalized patients and health care workers as an accepted norm: Making it legitimate to remind health care workers about hand hygiene

BACKGROUND

Despite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs.

METHODS

Intervention type 2 design and examination of 2 population groups-HPs and HCWs-before and after intervention by means of mixed methods research.

RESULTS

Both HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation.

CONCLUSIONS

To overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.

A family empowerment strategy is associated with increased healthcare worker hand hygiene in a resource-limited setting

BACKGROUND

Guidelines recommend empowering patients and families to remind healthcare workers (HCWs) to perform hand hygiene (HH). The effectiveness of empowerment tools for patients and their families in Southeast Asia is unknown.

METHODS

We performed a prospective study in a pediatric intensive care unit (PICU) of a Vietnamese pediatric referral hospital. With family and HCW input, we developed a visual tool for families to prompt HCW HH. We used direct observation to collect baseline HH data. We then enrolled families to receive the visual tool and education on its use while continuing prospective collection of HH data. Multivariable logistic regression was used to identify independent predictors of HH in baseline and implementation periods.

RESULTS

In total, 2,014 baseline and 2,498 implementation-period HH opportunities were observed. During the implementation period, 73 families were enrolled. Overall, HCW HH was 46% preimplementation, which increased to 73% in the implementation period (P < .001). The lowest HH adherence in both periods occurred after HCW contact with patient surroundings: 16% at baseline increased to 24% after implementation. In multivariable analyses, the odds of HCW HH during the implementation period were significantly higher than baseline (adjusted odds ratio [aOR], 2.94; 95% confidence interval [CI], 2.54-3.41; P < .001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs evening or weekend), and HH moment.

CONCLUSIONS

The introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese PICU. Future research should explore acceptability and barriers to use of similar tools in low- and middle-income settings.

Hand hygiene compliance of patients' family members in India: importance of educating the unofficial 'fourth category' of healthcare personnel

INTRODUCTION

In India, due to manpower constraints, patients' family members are often actively involved in healthcare activities of their near and dear ones. They have significant contact with the patient at all World Health Organization (WHO) 'five moments for hand hygiene'. This study analysed the impact of decade-long awareness campaigns on the hand hygiene compliance (HHC) by our patients' carers.

METHODS

Trained infection control nurses observed the HHC at each of the five moments for patients' attendants in different hospital settings from January 2014 to December 2018. Compliance was calculated as percentage of events divided by total opportunities.

FINDINGS

A total of 7302 opportunities were observed with an overall compliance of 46.1% (35.5% in 2014 to 48.2% in 2018, P < 0.0001). Compliance at WHO moments 1, 2, 3, 4, and 5 was 51.0%, 47.4%, 67.6%, 48.8%, and 24.3% respectively. Among family members, mothers of newborns had a much higher HHC (77%) than others (44.5%) (P < 0.0001). Also, the compliance was higher in medical versus surgical wards and in paediatric wards versus adult wards (P < 0.0001 in both).

CONCLUSION

This is the first study on family members' HHC in a hospital setting in a low- and middle-income country. The study shows that family members, once trained, exhibit fairly good HHC while caring for their patients, especially mothers of newborns. It is worthwhile empowering and educating patient attendants about the importance and process of hand hygiene as it is likely to result in immense benefit for patients.

An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting

AIMS AND OBJECTIVES

To review patients' and healthcare professionals' perceptions of patient involvement in promoting hand hygiene compliance in the hospital setting.

BACKGROUND

Initiatives continue to emphasise the importance of involving patients in their safety at the point of care. A patient-centred care approach aimed to empower patients to become active members of the healthcare team. However, understanding the perceptions of patients and healthcare professionals of patient involvement in promoting hand hygiene compliance among healthcare professionals has yet to be fully explored.

DESIGN

Integrative literature review.

METHODS

A five-stage review process informed by Whittemore and Knafl's methodology was conducted. MEDLINE and CINAHL were searched for papers published between January 2009-July 2017. Data were extracted manually, organised using NVivo 11 and analysed using thematic analysis.

RESULTS

From an identified 240 papers, 19 papers were included in this review. Thematic analysis revealed two main themes with three related subthemes. Patients were willing to remind healthcare professionals (especially nurses) to wash their hands, healthcare professionals perception towards patients' involvement varied from one study to another. However, an overall positive attitude towards patient involvement was related to how patients asked and how healthcare professionals responded to being asked.

CONCLUSION

There is limited evidence regarding patients' actual intention to ask healthcare professionals to wash their hands, and some evidence that patients are reluctant to do so. Further research is required to understand this area thoroughly, including which situations patients would feel more empowered to speak up.

RELEVANCE TO CLINICAL PRACTICE

Simple messages promoting patient involvement may lead to complex reactions in both patients and healthcare professionals. It is unclear, yet how patients and staff react to such messages in clinical practice. There is a need for a deeper understanding of how they can work together to support harm free care.