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

PART V. PATIENT INVOLVEMENT IN HAND HYGIENE PROMOTION
implementation of an empowerment model for hand hygiene
was initiated in collaboration with Patients for Patient Safety.
In studies undertaken in the USA and the United Kingdom,
McGuckin and colleagues 803-805 reported on patients’ willingness
to be empowered and involved in hand hygiene by asking their
HCWs to clean their hands. They documented that 80–90%
of patients will agree to ask in principle, but the percentage
of those that actually asked their HCW is slightly lower at
60–70%. A recent survey of consumers on their attitudes
about hand hygiene found that four out of five consumers
said they would ask their HCW “did you wash/sanitize your
hands?” if their HCW educated them on the importance of hand
hygiene. 874 A patient’s willingness to be involved, empowered
or engaged is dependent on the overall environment of the
organization and its attitudes toward patient safety and patient
involvement. 876,1036,1123,1124
4.1.2 Barriers to patient empowerment
There are several different theories from various disciplines that
provide insight into the barriers of hand hygiene compliance
that may apply to patient involvement. These theories include
cognitive, behavioural, social, marketing, and organizational
theories that may be valuable when considering barriers to
be overcome, or a strategy to involve and engage patients. 876
Pittet 789 discusses in some detail the promising effect of
the theory of ecological perspective as part of a multimodal
programme to increase hand hygiene compliance. In this
theory, similar to that of positive deviance, 1115,1116 behaviour is
viewed as affecting and being affected by multiple factors, and
both influences and is influenced by the social environment.
Although further assessment of these theories is needed,
they do appear to have a bearing on some of the barriers
of patient empowerment. Three barriers that can lessen
patient involvement are: 1) intrapersonal; 2) interpersonal;
and 3) cultural. 1125 . Intrapersonal factors include psychological
vulnerability, acute pain, and illness, 1126 and each can be
influenced by a lack of knowledge 1127 and professional
domination. 1128 Interpersonal factors centre on the importance
of communication and the need to use clear, simple language
so that expectations are apparent. 1129 Cultural factors such as
cultural marginalization, caused by social pressure, can have
a significant impact on “speaking up”. 1130 In addition to these
barriers, a significant factor often perceived by the patient is
the fear of a negative impact/response from their HCWs. 1131
This barrier was explored in an acute care rehabilitation unit
where patients are often dependent on their HCWs for activities
of daily living. The authors reported that 75% of patients were
comfortable asking their HCWs “did you wash/sanitize your
hands?” 805 It is important to note that empowerment is a major
part of the rehabilitation process and, therefore, this may have
been a motivating factor for empowerment in these patients.
Table V.4.1
Countries and territories with national strategies for patient
empowerment (as at October 2008)
Country
• Australia
• Belgium
• Canada
• England and Wales
(http://www.npsa.nhs.uk/cleanyourhands/in-hospitals/pep)
• Ireland
• Northern Ireland
• Norway
• Ontario (Canada)
• Saudi Arabia
• USA
(http://www.jointcommission.org/patientsafety/speakup)
Although HCWs are trained and motivated to provide the best
care possible, they are often faced with barriers that are more
system-related than behavioural. Empowering a patient covers
issues that go beyond decision-making and involve more
individual interests and cultural parameters. Acknowledging
different views on patient empowerment and dealing with them
in the context of an organization, culture, or community will be
necessary when removing barriers to patient empowerment,
involvement or participation in hand hygiene compliance.
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