Review article
Patient-centered hand hygiene: The next step in infection prevention

https://doi.org/10.1016/j.ajic.2012.02.006Get rights and content

Hand hygiene has been recognized as the most important means of preventing the transmission of infection, and great emphasis has been placed on ways to improve hand hygiene compliance by health care workers (HCWs). Despite increasing evidence that patients’ flora and the hospital environment are the primary source of many infections, little effort has been directed toward involving patients in their own hand hygiene. Most previous work involving patients has included patients as monitors or auditors of hand hygiene practices by their HCWs. This article reviews the evidence on the benefits of including patients more directly in hand hygiene initiatives, and uses the framework of patient-centered safety initiatives to provide recommendations for the timing and implementation of patient hand hygiene protocols. It also addresses key areas for further research, practice guideline development, and implications for training of HCWs.

Section snippets

Historical perspective

It is well documented that the hands of HCWs are involved in the transmission of health care–associated pathogens. Transmission via the hands of HCWs accounts for a high proportion of HAIs, and improvement of hand hygiene practices has been linked to reduced transmission of health care–associated pathogens and reduced infection rates.3, 4, 5, 6, 7, 8 Current evidence clearly indicates that increasing hand hygiene compliance directly results in a reduction in HAIs, and both the CDC and the WHO

Emerging perspective

Patients may be involved in the transmission of pathogens and HAI risk in 4 significant ways: through the transfer of pathogens within the environment, by directly spreading pathogens to other patients, by cross-contamination through direct contact with HCWs, and by increasing their own risk of infection from an endogenous source. Organisms residing on the skin can be transferred by hands to other surfaces; thus, patients’ hands can transfer pathogens to HCWs, to their surrounding environment,

Implications for practice

In the health care setting, current best practices to promote hand hygiene behavior include the use of multimodal strategies. As with HCWs, successful patient hand hygiene programs will likely require a multimodal approach that emphasizes important features, including the formulation, design, and availability of hand hygiene resources; timing and technique for hand hygiene behavior; education and training of patients and caregivers; monitoring adherence and providing feedback and reminders; and

Future research

HAIs occur in 1.7 million hospitalized US patients every year, causing approximately 100,000 deaths and costing $6.7 billion annually.72, 73 Yet the focus on hand hygiene as the single most effective means of preventing the spread of infection has primarily targeted HCWs. As a result, patients have been relegated to roles that simply support and encourage hand hygiene practices of others, rather than being engaged as active participants. The evidence presented in this review indicates that this

Acknowledgment

We wish to acknowledge the assistance of Ebie Hoist, Strategic Gear, in the preparation of this article and to Ruth Carrico, RN, PhD, who provided scientific and technical assistance and served as a scientific advisor to the development of this article.

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    Publication of this article was made possible by GOJO Industries, Inc.

    Conflict of interest: T.L., M.-B.C., and S.A. received an honorarium or educational grant from GOJO Industries for their participation in the Consortium. J.B. is an employee of GOJO Industries.

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