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Patient empowerment initiatives for
CDI should include education of patients and family members on the risk for recurrence and transmission and measures that they may take to reduce the risk . These measures include frequent handwashing with soap and water , cleaning and disinfection of bathrooms and other hightouch areas with bleach or other sporicidal disinfectants , frequent laundering of clothing and bedding , and avoidance of unnecessary antibiotic prescriptions .”
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devices ; before eating ; after using the restroom ; and when entering or leaving the patient ’ s room . The fifth moment is when healthcare personnel enter the patient ’ s room .
The challenge , as pointed out by a recent study , is that hygiene behavior in a patient ’ s private life can be an indicator for their willingness to engage in hand hygiene and other practices that could benefit them during a hospital stay .
“ Patients who do not follow infection prevention practices at home may be less likely to follow recommended practices in the hospital ,” says Donskey . “ These patients may require more education and reminders .”
There is evidence that patients as well as family and visitors bring their handwashing beliefs with them . In a study by Lee , et al . ( 2021 ), patients , families , and visitors at a pediatric and maternity hospital were both surveyed and observed to assess hand hygiene knowledge , attitudes , and practices . The researchers identified a clear preference for handwashing with soap and water over the use of alcohol-based handrub , both in survey responses and in observed hand hygiene behavior . Self-reported hand hygiene rates were higher than observed rates , with an overall observed hand hygiene rate of 10.3 percent . Beliefs about the consequences of failing to wash one ’ s hand were the main driver for hand hygiene . The authors suggest that development of interventions to improve hand hygiene should focus on correcting misconceptions and emphasizing consequences of failing to perform hand hygiene in the healthcare setting .
In his review , Donskey ( 2023 ) noted that a second intervention that can be shared with patients is improved bathing habits and reducing clothing contamination . He points to studies ( Bobulsky , et al . 2008 , and Sethi , et al . 2010 ) demonstrating that nearly 90 percent of patients with newly diagnosed CDI have contamination of their skin . The frequency of C difficile skin contamination decreased during treatment but more than half of successfully treated patients had recurrent spore shedding with skin contamination up to four weeks after treatment . Additionally , studies ( Chang , et al 2009 and
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Kanwar , et al . 2018 ) show that patients with MRSA colonization or infection also often have skin and clothing contamination . MRSA is frequently transferred from the skin of colonized patients to gloved hands and can also be transferred either directly or indirectly via hands of healthcare personnel to surfaces .
Interventions to reduce clothing and skin contamination could potentially reduce the risk for transfer of healthcare-associated pathogens to surfaces and to personnel or other patients . For CDI patients , showering was significantly more effective in reducing skin contamination than bed baths . MRSA-colonized patients who reported changing clothing daily were significantly less likely to have clothing contamination than those who did not ( 50 percent versus 90 percent , respectively ).
There are also implications for better environmental cleaning related to patients ’ hand-contact of surfaces in the near-bed radius of the room . A patient being in bed is a well-known barrier to environmental services personnel being able to clean high-touch surfaces such as the bed rail or overbed table .
“ Patients colonized with bacterial pathogens or Candida auris often have hand contamination and shed the pathogens onto nearby surfaces ,” Donskey says . “ Daily disinfection of surfaces in the rooms of colonized patients can reduce acquisition of the pathogens on hands of personnel . Patients who are not colonized with healthcare-associated pathogens often acquire them on their hands while in the hospital , presumably in part due to contact with contaminated surfaces . Daily disinfection of surfaces could potentially reduce the risk that patients will acquire colonization with pathogens .”
A third intervention with patient-education implications is empowering patients to reduce overuse of medical devices such as indwelling urinary catheters and central venous catheters , which tend to remain in place longer than necessary , especially if the patient preferred to have a Foley catheter if unable to get out of bed independently . Anderson , et al . ( 2013 ) found that less than one-third of patients with central venous catheters reported having
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a caregiver discuss infection risks or receive information about central line-associated blood stream infection ( CLABSI ).
As Donskey ( 2023 ) observes , “ Studies are needed to determine if educational patient empowerment initiatives could be beneficial in reducing overuse of urinary and central venous catheters . It is possible that improved knowledge of the risks of catheters might empower patients to participate more actively in decisions regarding the necessity of catheter insertion and continuation and reduce requests for catheter placement for convenience .”
A fourth intervention cited by Donskey ( 2023 ) addresses enlightening patients about the acquisition of pathogens from contaminated hospital floors , with the solution being the wearing of slippers . Haq , et al . ( 2023 ) found that hospitalized patients who wore socks whenever they were out of bed resulted in a significant reduction in transfer of a benign virus from the floor to the feet of patients and to high-touch surfaces and hands . As Donskey ( 2023 ) notes , “ These results suggest that having patients wear slippers could provide a simple and low-cost intervention to decrease the risk for acquisition of pathogens from floors . Encouraging patient hand hygiene after contact with slippers or socks may also be beneficial .”
A fifth intervention involves targeting specific pathogens such as C . difficile , which causes illness that greatly impacts patients ’ quality of life and can easily spread to family members . Studies have confirmed that few , if any , patients receive educational materials about C . difficile infection ( CDI ) prevention .
As Donskey ( 2023 ) emphasizes , “ Patient empowerment initiatives for CDI should include education of patients and family members on the risk for recurrence and transmission and measures that they may take to reduce the risk . These measures include frequent handwashing with soap and water , cleaning and disinfection of bathrooms and other high-touch areas with bleach or other sporicidal disinfectants , frequent laundering of clothing and bedding , and avoidance of unnecessary antibiotic prescriptions . Patients and family members should be aware that hand washing with
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