soap and water is effective in reducing the burden of spores on hands through mechanical removal , whereas alcohol hand sanitizer is ineffective .”
Bundles have been shown to help reduce variation in practice by healthcare personnel and contribute to improved outcomes for patients , so it ’ s no surprise that patient empowerment bundles of evidence-based practices could be beneficial to patient-education efforts . However , as Donskey ( 2023 ) cautions , “ Studies would be required to determine how to effectively engage patients and to determine if involvement of patients can improve implementation of evidence-based care bundles .” He adds , “ More evidence is needed to support many of the individual measures described in this review . Nevertheless , it is likely that a bundle of prevention measures may be more effective than initiatives focused on single interventions such as patient hand hygiene . In the absence of evidence that specific measures reduce infections or transmission , approaches that are feasible , inexpensive , and microbiologically plausible could be considered for inclusion in bundles .”
While all the interventions Donskey reviewed in his paper have merit , he emphasizes that the simplest interventions are most likely to succeed .
“ Patient hand hygiene initiatives are relatively easy to implement because most people are aware that hand hygiene is important ,” he says . “ Many patients just need improved access to hand sanitizer and education on when to clean their hands . Others may benefit from reminders or assistance from staff . Interventions that require patients to question their providers are more challenging . Approaches that are non-confrontational can make these interventions more feasible . For example , in our experience , patients rarely ask providers if they cleaned their hands , but most are willing to display a sign thanking providers for performing hand hygiene .”
One of the central challenges for patient empowerment , Donskey says , is development of interventions that will be sustained over time . “ Many studies have demonstrated that interventions can increase patient hand hygiene or empower patients to provide feedback on hand hygiene to personnel ,” he adds . “ However , such interventions often end when the study is completed . More widespread incorporation of patient empowerment approaches into infection prevention may require additional evidence of meaningful benefits to patients or recommendations from regulatory bodies that these approaches should be standard practices .”
While all healthcare personnel play a role in empowering patients about HAI
infection prevention , Donskey says he believes infection preventionists “ play an essential role in educating providers and ensuring that educational materials for patients are available and accurate .” He continues , “ They can also identify opportunities to incorporate patient empowerment practices into existing bundles for prevention of HAIs .”
Looking to the Future of Patient Empowerment
Future goals for patient empowerment could include :
• Incorporation of patients and families into existing educational care bundles of evidence-based practices in infection prevention and patient safety
• Development of bundled measures that all patients can use to reduce their risk for healthcare-associated infections
• Development of bundled interventions tailored to patients infected with individual pathogens or specific patient populations with common risk factors .
Source : Donskey , 2023
Regarding considerations for appropriate patient-education strategies , Sharp , et al . ( 2014 ) suggest that patients should be offered HAI-related information in a digestible , non-technical format that patients are reasonably expected to understand . They add , “ Some general background information about types of HAIs and their common causes is essential . Patients should be informed that the problem is systemic to prevent them from viewing HAIs as unique to a single institution . Further , given differences in HAI risk across institutions , emphasis should be placed on those infections that pose problems in the facility or department . Risk information materials should avoid complex statistics , focus on populations and procedures associated with the highest HAI risk , and discuss common complications arising from HAIs in a manner that empowers patients to recognize and report symptoms . Hospitals should inform patients about institutional prevention measures to reassure patients that action is being taken and to inform them about policies and practices that might affect their care , such as surveillance cultures and isolation precautions . Finally , essential to patient empowerment , patients should be informed of steps they might take to minimize their own risk of acquiring an infection or any complications that might ensue .”
References :
Anderson M , Ottum A , Zerbel S , Sethi A and Safdar N . Are hospitalized patients aware of the risks and consequences of central line-associated bloodstream infections ? Am J Infect Control , 41 ( 2013 ), pp . 1275-1277 .
Bobulsky GS , Al-Nassir WN , Riggs MM , Sethi AK and Donskey CJ . Clostridium difficile skin contamination in patients with C . difficile-associated disease . Clin Infect Dis , 46 ( 2008 ), pp . 447-450 .
Chang S , Sethi AK , Eckstein BC , Stiefel U , Cadnum JL and Donskey CJ . Skin and environmental contamination with methicillin-resistant Staphylococcus aureus among carriers identified clinically versus through active surveillance . Clin Infect Dis , 48 ( 2009 ), pp . 1423-1428 .
Donskey , CJ . Empowering patients to prevent healthcare-associated infections . Am J Infect Control . Vol . 51 , Issue 11 , Supplement Pages A107-A113 . November 2023 .
Gudnadottir U , Fritz J , Zerbel S , Bernardo A , Sethi AK , Safdar N . Reducing healthcare-associated infections : patients want to be engaged and learn about infection prevention . Am J Infect Control , 41 ( 2013 ), pp . 955-958 .
Haq MF , Alhmidi H , SN Redmond , et al . A randomized trial to determine whether wearing slippers reduces transfer of bacteriophage MS2 from floors to patients and surfaces in hospital rooms . Infect Control Hosp Epidemiol , 44 ( 2023 ), pp . 670-673 .
Kanwar A , Cadnum JL , Thakur M , Jencson AL and Donskey CJ . Contaminated clothing of methicillin-resistant Staphylococcus aureus ( MRSA ) carriers is a potential source of transmission . Am J Infect Control , 46 ( 2018 ), pp . 1414-1416 .
Knighton SC , Richmond M , Zabarsky T , Dolansky M , Rai H and Donskey CJ . Patients ’ capability , opportunity , motivation , and perception of inpatient hand hygiene . Am J Infect Control . Vol . 48 , issue 2 . Pages 157-161 . February 2020 . Lee Z , Lo J , Luan YL , et al . Patient , family , and visitor hand hygiene knowledge , attitudes , and practices at pediatric and maternity hospitals : A descriptive study . Ame J Infect Control . Vol . 49 , issue 8 . Pages 1000-1007 . August 2021 . https :// doi . org / 10.1016 / j . ajic . 2021.02.015
Loveday HP , Tingle A and Wilson JA . Using a multi-modal strategy to improve patient hand hygiene . Am J Infect Control . 49 ; 740−745 . 2021 .
Rai H , Knighton S , Zabarsky TF and Donskey CJ . A randomized trial to determine the impact of a 5 moments for patient hand hygiene educational intervention on patient hand hygiene . Am J Infect Control , 45 ( 2017 ), pp . 551-553 .
Sethi AK , Al-Nassir WN , Nerandzic MM , Bobulsky GS and Donskey CJ . Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C . difficile infection . Infect Control Hosp Epidemiol , 31 ( 2010 ), pp . 21-27 .
Sharp D , Palmore T and Grady C . The ethics of empowering patients as partners in healthcare-associated infection prevention . Infect Control Hosp Epidemiol , 35 ( 2014 ), pp . 307-309
Sunkesula VC , Knighton S , Zabarsky TF , Kundrapu S , Higgins PA and Donskey CJ . Four moments for patient hand hygiene : a patient-centered , provider-facilitated model to improve patient hand hygiene . Infect Control Hosp Epidemiol , 36 ( 2015 ), pp . 986-989 .
march 2024 • www . healthcarehygienemagazine . com •
15