WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
Positive deviance is based on the observation that, in most
settings, a few at-risk individuals develop uncommon, beneficial
practices and, consequently, experience better outcomes
than neighbours with similar risks. 1113,1114 Recognition of these
individuals and identification and explanation of their uncommon
behaviour allows the design of behaviour change activities that
can lead to widespread adoption of beneficial behaviour. This
approach, which takes advantage of the community’s existing
assets, was originally developed for combating childhood
malnutrition, 1115,1116 but has also been applied to various healthcare
programmes such as newborn care or reducing the spread
of MRSA. 1117,1118 It is now being seen as a means to provide a
framework for facilitating empowerment.
Positive deviance could be used to promote hand hygiene
and patient empowerment. The strategy involves: 1) social
mobilization; 2) information gathering; and (3) behaviour change.
Social mobilization is an opportunity for health-care settings to
identify problems and find solutions to increase compliance.
This can be done by bringing together the individuals who have
a vested interest in the problem. Information-gathering would
offer an opportunity for individuals to identify the best ways
to involve patients and HCWs. Behavioural change can be
developed through a partnership that takes responsibility for
implementation. For some communities, the process of positive
deviance may reveal a lack of hand hygiene products, cultural
barriers to empowerment, or the need to develop networks of
champions.
The partnership of HCWs and patients can facilitate the process
of empowerment if HCWs recognize patients as equal partners.
Positive deviance can be used to find solutions to common local
issues within a community and encourage behaviour change.
4.
Hand hygiene compliance and empowerment
Multimodal programmes for increasing hand hygiene compliance are now recommended as the most reliable,
evidence-based method for ensuring sustainable improvement. 60,713 <strong>WHO</strong> has developed and tested a multimodal
Hand Hygiene Improvement Strategy (see Part I, Section 21) to translate into practice the present guidelines.
Although patient empowerment was already referenced in the 2006 Advanced Draft of the <strong>Guidelines</strong> 59 and
explicitly stated as one of the final recommendations, the emphasis placed upon it within the associated
implementation strategy has been limited. <strong>WHO</strong> is committed to informing and educating patients about the
importance of hand hygiene and their potentially powerful role in supporting improvement. 767 This is mirrored
across a growing number of countries of the world that are incorporating patient empowerment into their national
strategies. (Table V.4.1)
4.1 Patient and health-care worker empowerment
4.1.1 Willingness to be empowered
Miller & Farr 1119 surveyed patients’ knowledge of HCAI in the
USA by asking if they were satisfied with the information they
received about infection control and if they were willing to pay
for increased investment in infection control programmes within
their hospital. Responses revealed that 70% of patients were
concerned about the risk of infection, 69% said the risk was
never explained, and 57% said they would be willing to pay
for better infection control programmes and information on
infections.
The NPSA for England and Wales assessed patients’ views
on involvement as part of their “cleanyourhands” campaign
and reported that 71% of respondents wanted to be involved
in improving hand hygiene practices. 1029 Similar results were
reported by an acute care trust, 1120 where 79% of patients
thought that they should be involved in hand hygiene
improvements.
A willingness to be empowered is dependent on patient input
during the development of the programme. Entwistle and
colleagues 1121 reviewed the content of five leading patient safety
directives in the USA; they reported that the programmes
had been developed without input from patients and lacked
information about what the HCWs needed to do and what
support should be given to patients. In 2001, the National
Patient Safety Foundation Advisory Council in the USA took up
the concern about consumer involvement and developed a new
programme with input from patients and families, “Patients and
Families in Patient Safety: Nothing About Me, Without Me”, as a
call to action for health-care organizations at all levels to involve
patients and families in systems and patient safety problems. 1122
In 2004, <strong>WHO</strong> launched the World Alliance for Patient Safety to
raise awareness and political commitment to improve the safety
of care in all its Member States. A specific area of work, Patients
for Patient Safety, was designed to ensure that the wisdom of
patients, families, consumers, and citizens, in both developed
and developing countries, is central in shaping the work of the
Alliance. In 2007, as part of the <strong>WHO</strong> First Global Patient Safety
Challenge, “Clean Care is Safe Care”, the development and
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