World Patient Safety Day: Involve Patients & Families in Hand Hygiene

The World Health Organization (WHO) established World Patient Safety Day in 2019 to call for “global solidarity and concerted action … to improve patient safety. The Day brings together patients, families, caregivers, communities, health workers, health care leaders and policy-makers to show their commitment to patient safety.”

Note the inclusive call to action: WHO recognizes that patients and families must be involved in efforts to protect patient safety. Patient safety initiatives cannot exclusively be top-down efforts, created and imposed by healthcare providers and policy makers. Patients and families have a crucial role to play.

Healthcare-associated infections (HAIs) are a major threat to patient safety. They are the second leading cause of adverse events among hospitalized patients (medication errors are the first), and poor hand hygiene is a major contributing factor. According to the WHO Guidelines on Hand Hygiene in Health Care, most hospitals and healthcare institutions have “hand hygiene defect rates of six per ten opportunities or greater.” In other words, clinicians fail to adequately perform hand hygiene as often as 60% of the time.

Evidence has repeatedly shown that “Adequate and thorough hand hygiene is the single most important, least costly, and most basic method of reducing HAIs in hospitals,” so healthcare institutions have invested significant resources in hand hygiene initiatives. Many hospitals have purchased electronic hand hygiene systems and hosted numerous staff education events – while ignoring the essential role patients and families play in promoting hand hygiene.

How Patients & Families Can Support Hand Hygiene 

In 2002, the Joint Commission launched their “Speak Up” program, which encourages patients to take a role in preventing health care errors by “becoming active, involved, and informed participants in the health care team.” Clinical research had found that patient participation programs can help to increase healthcare workers’ hand hygiene rates (by as much as 94%, according to one study), so patients and family members were encouraged to ask healthcare workers to perform hand hygiene.

That’s easier said than done for most patients and family members, who are acutely aware of the power differential between patients and healthcare workers. One study found that 75% of patients “did not feel comfortable asking their nurse or physician to perform hand hygiene.”

Explicitly inviting patients to ask about hand hygiene seems to ease their discomfort somewhat. Approximately 60-70% of patients and families who are encouraged to discuss hand hygiene with their providers actually do so.

Patients & Families Need to Perform Hand Hygiene Too

Interestingly, most of the efforts to reduce HAIs have focused on healthcare workers’ hand hygiene practices – and completely ignore hand hygiene of patients and visitors. Though hospital workers’ hands are a likely source of transmission of the pathogens that cause HAIs, it’s not prudent to neglect the hand hygiene of patients and visitors.

A 2012 article in the American Journal of Infection Prevention notes that “literature strongly reinforces the need for patient hygiene programs.” So, it’s important for healthcare providers to educate patients, family members, and other visitors about hand hygiene as well. Staff also must ensure that necessary hand hygiene supplies – soap and water, or alcohol-based hand rub — are plentiful and available. Some patients and visitors may need reminders and assistance to perform hand hygiene.

Promoting Patient & Family Involvement

Hospitals that want to decrease HAIs and promote patient safety will invest in electronic hand hygiene systems and actively involve patients and family members. Here’s how:

• Give patients and visitors a hand hygiene “tip sheet” that details the links between hand hygiene and patient safety; encourages them to clean their hands before visiting or eating, and after using the bathroom or coughing or sneezing; and invites them to ask healthcare workers if they’ve performed hand hygiene.

• Verbally encourage patients and visitors to support hand hygiene. Teach patients and visitors phrases such as, “I didn’t see you clean your hands when you came in. Would you mind cleaning them?” or “Have you washed your hands?”
  

• Provide easily accessible hand hygiene supplies. Placing alcohol-based hand rub on patients’ bedside tables when delivering meal trays, for instance, encourages hand hygiene before eating.

• Explain your hand hygiene system. Many patients and families are unfamiliar with electronic hand hygiene systems. Tell them about the system and show them how it works. This effort demonstrates your facility’s commitment to hand hygiene and patient safety, which will likely increase patients’ and visitors’ willingness to support excellent hand hygiene. It may also increase patient satisfaction and trust, as a recent study found that nearly 2/3 of patients will consider switching health systems if they do not think the institution is serious about sanitation and patient safety.

World Patient Safety Day is the perfect time to involve patients and families in hand hygiene. Here at SwipeSense, we’re committed to improving hand hygiene in healthcare facilities. Our easy to install, non-disruptive hand hygiene application empowers facilities to create lasting behavior change with actionable insights.