August 18, 2017
2 min read

Patient empowerment intervention improves hand hygiene

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Adult patients and the parents of hospitalized children supported the use of a patient empowerment tool to encourage hand hygiene in physicians, whereas physicians preferred a verbal reminder, according to findings from a recently published survey.

“A number of studies have examined the role of patient involvement in health care worker hand hygiene,” Allison Lastinger, MD, of the section of infectious diseases at the West Virginia University School of Medicine, and colleagues wrote. “Some have used posters, patient videos, buttons and brochures to promote patient empowerment. Most patients are interested in participating in their care, but many patients are hesitant to do so because of their discomfort or embarrassment.”

The researchers introduced a patient empowerment tool to an ongoing hand hygiene strategy at a 531-bed tertiary care teaching hospital in December 2015. The tool, which accompanied patient surveys, promotional posters and direct observations by health care professionals, consisted of a laminated sign with a reminder phrase (eg, “Did you wash your hands?”) attached to a tongue depressor. Lastinger and colleagues surveyed adult patients on two wards, as well as the parents of children in a pediatric ward (n = 202). They also administered a different survey to resident (n = 111) and attending physicians (n =192) in the pediatrics, family medicine and internal medicine departments via email.

The hospital’s hand hygiene compliance rate was 48% in 2015 and rose to roughly 75% in 2016, the researchers wrote.

One hundred-fourteen patients and parents of patients returned their surveys, Lastinger and colleagues wrote. The participants’ mean age was 34.7 years, and most participants (79.5%) were women. Nearly three quarters (71.9%) of parents and 65.4% of patients reported that the empowerment tool was helpful in reminding physicians to wash their hands, Lastinger and colleagues wrote. More parents felt it was their role to remind a physician (95.6% vs. 77.6%; P = .33) or nurse (99.1% vs. 86%; P = .68) to wash their hands than adult patients.

Overall, most parents felt comfortable using the patient empowerment tool (77% for physicians and 81.4% for nurses), as did most adult patients (64.8% for physicians and 71.2% for nurses), according to Lastinger and colleagues. Patients (63.8%) and parents (69.6%) agreed that the patient empowerment tool made them feel more in control of their treatment (P = .49).

Twenty-nine residents (26.1% response rate) and 60 attending physicians (31.3% response rate) responded. More resident physicians (65.5%) than attending physicians (49%) agreed that patients should play a role in reminding doctors to wash their hands (P = .15).

Of those who supported patient involvement in hand hygiene, 34 of 45 (75.6%) said they supported patient involvement because it had a positive effect on their relationships with patients, the researchers wrote. Of 37 physicians who did not support patient involvement, 14 (37.8%) responded that it was not the patient’s responsibility, (16.2%) thought it was embarrassing to the physician and (13.5%) thought it would negatively impact the patient-physician relationship.

Physicians generally indicated that they would prefer the patient simply use words to ask them to wash their hands than use the patient empowerment tool (P = .008), Lastinger and colleagues wrote.

“Most patients and family members surveyed indicated that they would feel comfortable using the Patient Empowerment Tool (PET) to remind physicians and nurses to perform hand hygiene.  Only 54.9% of physicians surveyed felt that patients should be involved in reminding providers to perform hand hygiene,” Lastinger told Infectious Disease News. “I think these findings highlight the differences between how patients and physicians view patient empowerment.  We should continue to address the barriers to hand hygiene identified by health care providers and educate providers on the value of patient empowerment.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.

54% of physicians surveyed felt that patients should be involved in reminding providers to perform hand hygiene.