Patient Involvement and Empowerment
Q: Is it appropriate to encourage patients to remind staff to clean their hands?
A: The Guidelines recommendation states: "Encourage partnerships between patients, their families and HCWs to promote hand hygiene in health care settings." However, the current version of the Guidelines suggests the need for further study in this area to explore obstacles and facilitators in more detail. For this reason, a global survey of patients’ views on their involvement in hand hygiene is under way and the results of the survey, together with new evidence from the literature, will shape the final recommendations. Early indications are that across all regions, patients do want to be involved in efforts and initiatives to improve hand hygiene as a means of reducing health care-associated infections. Each country should consider the relevance of patient involvement and empowerment in their efforts to tackle these infections. Information Sheet 4 provides some information on patient involvement and hand hygiene improvement.
Q: What role do patients and visitors play in the spread of infection?
A: The Five Moments for Hand Hygiene illustrates in a simple manner the times when hand hygiene should be undertaken in health care, based on the theory of pathogen transmission. Patients themselves can transfer pathogens from one site of their body to another during the "Before Aseptic Task" moment. If patients are having contact with their wound or the insertion site of a device, hand hygiene should be encouraged (the alcohol-based handrubs will enable easy hand hygiene to be performed).
In the same way, if visitors are having contact with the patient, in a way which corresponds with any of the Five Moments, hand hygiene should be performed. In some contexts, visitors provide much of the day-to-day routine care, and therefore should be encouraged to use the handrubs in accordance with the Five Moments. In instances where visitors are likely to have physical contact with more than one patient, then hand hygiene should be performed according to the Five Moments.
Q: Some health care facilities actively promote hand hygiene by all staff and visitors entering a ward - is this a good approach?
A: The WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) clearly recommend alcohol-based handrubbing at the point of care. The approach of positioning alcohol-based handrubs at locations remote to the patient (e.g. at the entrance to every ward or in corridors or at health-care facility entrances), has been taken in some countries with the rationale that this provides a strong message that the health-care facility takes the issue of hand hygiene seriously. However, on closer examination of this approach, such a strategy might actually be damaging to long-term success and could result in inappropriate actions and misunderstandings by both staff and patients about how pathogens spread. It can encourage inappropriate and illogical hand hygiene action, which does not correspond to any real indication, and therefore does not contribute to reductions in HAI. Unless educational investment is made to ensure that staff and visitors understand the Five Moments for Hand Hygiene, compliance with the correct indications will likely be sub-optimal.