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

PART V. PATIENT INVOLVEMENT IN HAND HYGIENE PROMOTION
5.2.3 Role modelling
Role modelling in which the HCW behaviour towards hand
hygiene is influenced by either peers or superiors has been
shown to influence compliance and motivate the patient to be
empowered. 732,802,853,872,1142-1145
McGuckin and colleagues reported an increase in hand
hygiene compliance and alcohol-based hand rub use by
using “authority figures” as role models for empowerment. 853
The medical director, nurse manager, director of nursing, and
infection control professional dedicated to the medical/surgical
ICU recorded short audio messages about hand hygiene,
such as “we want 100% compliance with hand hygiene in our
ICU” and “remember to use sanitizer”, that were broadcast at
randomly timed intervals from the announcement speakers at
the nurses’ station. Christensen & Taylor 1142 question the use
of empowerment for the ICU patient and suggest that patients
need to have control restored before they can be empowered.
Lankford and colleagues 802 reported that a HCW’s hand hygiene
behaviour was influenced negatively when the HCW was in a
room with a senior staff member or peer who did not perform
hand hygiene. Sax and colleagues 732 identified social pressures
that could be considered a form of role modelling as highly
ranked determinants of good hand hygiene adherence: the
influence of superiors and colleagues on staff and patients.
In summary, programmes and models for empowering patients
and HCWs must be developed with an evaluation component
that includes both qualitative and quantitative measures to
determine not only what works, but under what conditions,
and within which organizational context the programme works.
Programmes in which there is some evidence of empowering
patients and HCWs are usually part of a multifaceted approach
and include one or all of the following: educational tools,
motivation tools, and role modelling. Many aspects of patient
empowerment remain unexplored; for example, the views of
HCWs on this topic are largely unknown. Also, as most studies
exploring the impact of patient empowerment on HCWs’ hand
hygiene practices were conducted in settings with low baseline
compliance rates, the impact has always been significant and,
therefore, the effect on settings with higher baseline compliance
remains unknown. In addition, because the studies were
short term, any sustainable effect has not been determined.
Finally, empowerment programmes require further testing in
settings where a multimodal promotion strategy – including
system change, monitoring and HCW performance feedback,
education, reminders in the workplace, and promotion of the
institutional safety climate – is being promoted.
6.
<strong>WHO</strong> global survey of patient experiences
A <strong>WHO</strong> survey was undertaken as part of the work of the Patient Involvement Task Force established during the
development process of these guidelines, to identify existing gaps in knowledge and to incorporate geographical
and culturally diverse perspectives related to patient empowerment and hand hygiene improvement. A twophase,
web-based survey was conducted between March 2007 and January 2008. The survey sought views on
infrastructure, barriers and facilitators, existing country strategies, and case-study examples. Detailed results are
presented in Appendix 6.
In summary, 459 completed surveys were received, with only
13% from <strong>WHO</strong> regions other than AMR and EUR. Infrastructure
to support hand hygiene varied by region with, as anticipated,
major constraints reported in AFR and SEAR. Of the 29% of
respondents who reported asking a HCW to wash/sanitize
their hands, 25% reported receiving a negative response. One
of the key findings is the impact that HCW encouragement
seems to have on the likelihood of patients feeling empowered
to ask about hand hygiene, with 86% reporting that they would
feel comfortable doing so if invited to. This decreased to 52%
when not invited, and increased to 72% when presented with a
scenario where failure to comply was observed. Furthermore,
respondents who had direct experience of an HCAI were more
likely to question the HCW (37% among those who had direct
experience vs 17% among those who did not). Details of the
study design, data analysis, and results of all questions, as well
as specific details from case-studies, can be found at http://
www.who.int/patientsafety/challenge/en.
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