Review articlePatient-centered hand hygiene: The next step in infection prevention
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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2022, International Journal of Nursing StudiesCitation Excerpt :This raises questions on the roles of clients and their families in infection prevention, especially as contact with nurses or professional caregivers is of relatively short duration (Shang et al., 2018). Some efforts have been made to engage and involve clients to become active partners in infection prevention, but this approach is still underused (Landers et al., 2012). Thus, further research to involve and engage clients and their families in infection prevention measures might prove fruitful in the prevention of home-based nursing care acquired infections.
An exploratory qualitative study of caregivers' knowledge, perceptions and practices related to hospital hygiene in rural Niger
2021, Infection Prevention in PracticeCitation Excerpt :This contrasts with a study in the same hospital, which found healthcare worker compliance with hand hygiene guidelines to be between 11 and 36% depending on the season [22], a level of compliance that was low but consistent with that reported in several other studies in similar settings. [6,26,27] One approach to collectively improve good hospital hygiene has involved empowering caregivers to participate in the monitoring of individual and staff hygiene behaviors and provide constructive performance feedback. [28] While the traditional hierarchical power structure between patients and healthcare personnel may pose a potential barrier to caregivers providing feedback to healthcare personnel [24,29,30], this could be mitigated by healthcare workers inviting caregivers to monitor their practices. [31,32]
Using a multimodal strategy to improve patient hand hygiene
2021, American Journal of Infection ControlCitation Excerpt :Studies investigating strategies to improve PHH have focused on a range of interventions, including education, adaptation of the World Health Organization (WHO) 5 moments to fit PHH moments and electronic reminders to improve self-initiated HH.18-23 Key considerations for promoting PHH including timing and technique, product design and placement, and education and training for patients, their families and HCWs.24 Furthermore, a different approach to HCW HH is indicated because the most critical moments for PHH will not match the 5 moments recommended for staff (WHO 2009); mobility and confinement affect the patients’ ability to perform HH without assistance, and the product formulations that are most appropriate and acceptable for patient hand cleansing are likely to be different to those of staff.24
Use of a verbal electronic audio reminder with a patient hand hygiene bundle to increase independent patient hand hygiene practices of older adults in an acute care setting
2018, American Journal of Infection Control
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.