Hand hygiene and infection in hospitals: what do the public know; what should the public know?

Improving public perceptions around cleanliness and health care associated infection in hospitals (service improvement)

A qualitative study was undertaken to understand public perceptions of hospital cleanliness and how this might be improved following national initiatives to reduce infection rates and invest in domestic services. Eleven focus groups were held across the West Midlands.

Results demonstrated that perceptions are attained from a variety of sources. For patients and visitors the things they see, hear, smell and taste in hospitals and health services shaped their perceptions of cleanliness. For the public the media, friends and family are important. Key factors for attention include: ensuring hospital floors, walls, ceilings, doors and toilets are kept clean, tidy, and unstained; an absence of strong odours; patients have the opportunity for regular baths/showers; staff have clean hands and uniforms, have short, clean finger nails and hair tied back; and eye-catching material on why cleanliness is important as well as what people need to do. Participants were generally unaware of the symptoms of MRSA, Clostridium difficile or Norovirus.

The results of the study suggest that attention needs to be focussed on developing effective communication strategies. This will only be possible by adopting a multifaceted approach and enabling collaborative working between infection control staff, communications teams and other frontline staff.

The effects of a poster in informing and empowering patients in infection prevention and control

Finding effective ways to change healthcare workers’ (HCWs) behaviour while informing and empowering patients is challenging. Providing patient information at critical points of care delivery may empower them to address lapses and change HCWs’ behaviour. In this study, posters detailing standards required for five high impact interventions were displayed in patients’ rooms. Research groups were: ‘pre-poster’ (months 1–2; n=142 patients); ‘poster’ (months 3–4; n=59); ‘no-poster’ (months 3–4; n=52); and ‘no-poster’ (months 5–6; n=104). Poster effectiveness was evaluated by a quantitative questionnaire ( n=357). Patients were asked if they identified lapses in five interventions by HCWs and whether patients had addressed them. Patient interviews ( n=10 per group) explored patients’ knowledge of interventions. Only patients with posters addressed lapses. Poster presence was associated with significant increase in noticing lapses in the first two weeks but decreased incidence in noticing lapses in weeks 3–8. There was significant aversion to reporting doctors’ lapses. Interviews showed that posters significantly increased respondents’ knowledge, suggesting that lapses noticed in weeks 1–2 and not noticed in weeks 3–8 by the ‘poster’ group were genuine lapses followed by a change in HCWs’ behaviour. HCW self-interest in avoiding complaints from patients coincides with the aim of the posters in improving standards.

Twenty-four-hour observational study of hospital hand hygiene compliance

This observational study measured healthcare workers' (HCWs'), patients' and visitors' hand hygiene compliance over a 24h period in two hospital wards using the 'five moments of hand hygiene' observation tool. Hand hygiene is considered to be the most effective measure in reducing healthcare-associated infections but studies have reported suboptimal levels of compliance. Most studies have used random observational time-periods for data collection and this has been criticised. We monitored a total of 823 hand hygiene opportunities (HCWs, N=659; patients and visitors, N=164). Among HCWs, compliance was 47% for doctors, 75% for nurses, 78% for allied health professionals, and 59% for ancillary and other staff (P<0.001). There was no difference in compliance between patients and visitors (56% vs 57%, P=0.87). Hand hygiene compliance varied depending on which of the five moments of hygiene HCWs had undertaken (P<0.001), with compliance before an aseptic task being 100% (3/3); after body fluid exposure 93% (86/93); after patient contact 80% (114/142); before patient contact 68% (196/290); and after contact with surroundings 50% (65/129). Lower levels of compliance were found for HCWs working during the early shift (P<0.001). For patients and visitors there was no evidence of an association between moments of hygiene and compliance. Levels of compliance were higher compared with previous reported estimates. Medical staff had the lowest level of compliance and this continues to be a concern which warrants specific future interventions.