Exploring patient participation in reducing health-care-related safety risks

ChApTER 3.
pATIENT pARTICIpATION IN hAND
hYGIENE IN BULGARIAN hEALTh CARE
Rossitza Vatcheva-Dobrevska
Patient participation in hand hygiene in Bulgarian health care
Introduction
Ensuring safety for everyone who comes into contact with health services is one of
the most important challenges to the health care system today. Safety consciousness is
supported by the reporting and analysis of medical errors as part of a learning culture
designed to prevent patient harm. It is well recognized that “access to high-quality
health care is a key human right, recognized and valued by the European Union” (1).
Accordingly, patients should expect every effort to be made to ensure their safety as
users of preventive and curative health services.
HAIs are a major patient safety issue worldwide. They are linked to failures in systems,
processes and to the behavioural practices of HCWs, patients and the general public
within and beyond the health care environment. More than 1.4 million people around
the world become seriously ill from such infections annually. It is estimated that 5–10%
of hospitalized patients in industrialized nations acquire one or more infections and
that 15–40% of those admitted to critical care are affected. Approximately half of HAIattributable
deaths are caused by the seven most common multidrug-resistant bacteria
and occur in the four main types of HAIs: urinary tract infections (UTIs) (27%), lower
respiratory tract infections (including pneumonia) (24%), surgical site infections (SSIs)
(17%) and BSIs (primary bacteraemia) (10.5%).
The European Centre for Disease Prevention and Control (ECDC) presented data
showing that HAIs are responsible directly for approximately 37 000 deaths annually
and contribute to a further 110 000 deaths across the EU. The burden on health care
systems is immense, resulting in an additional 16 million days of hospital stay per year.
Assuming the average daily cost of hospital stay is €334, the total annual health care cost
for the 27 countries belonging to the EU since 2007 can be estimated at €5.5 billion.
This figure does not, however, include the indirect costs linked to loss of income or the
hidden costs associated with physical and emotional suffering (2).
Content of this chapter
Bulgaria supports the development of measures aimed at limiting the spread of HAIs and
antimicrobial resistance and to improving quality and patient safety in line with the 2009
European Council recommendation on patient safety (3), which includes HAI prevention
and control (4). The aim of this chapter is to present an overview of the Bulgarian
experience of implementing hand hygiene through core preventive interventions in health
care facilities, including patient participation, and to highlight how this is supported by
national regulations, medical staff attitudes, education programmes and campaigns.
33