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APPENDICES Risk communication We were informed by the ward nurses that Mum had contracted a “little, of no concern” infection. We were given a broadsheet A4 paper with the initials MRSA and what they stood for, there was no other information given to my family whatsoever … 20 hours later she was in a coma and died 11 days later (narrative, United Kingdom). Building on the earlier questions exploring how best to communicate risks within the context of HCAI, the narrative forms explored both how the individuals had been informed of the acquired infection and whether they had been informed about any risk of HCAI whilst receiving care/treatment (Table 7). Table 7. Patient narrative – risk communication Country Infection/organism How told Informed of risk of HCAI while in hospital? India HIV Report Not answered United Kingdom MRSA Verbal No USA Septicaemia Verbal No Australia Urinary tract infection Not told No USA Urinary tract infection Not told No United Kingdom MRSA Verbal No USA MRSA Not told No USA Septicaemia Not told No USA Wound Verbal No United Kingdom C. difficile Leaflet No United Kingdom MRSA “Had to ask” No Conclusion The results of this study reinforce a number of findings from previous studies. Many individuals who have had an experience as a patient are interested in the possibilities of participating in hand hygiene improvement among HCWs in health-care settings. Most respondents are interested in and positive about empowerment; however, there were a number of caveats. The following action areas should be considered by any country or facility intent on introducing or strengthening this component of the strategy: • infrastructure for hand hygiene; • patient and HCW information and education; • risk communication; • alignment with culture. In particular, the survey reinforces the importance of programme development and the need for any patient empowerment strategy to be at one with the organizational culture and context. The survey results present an endorsement that patient empowerment should form one component of a multimodal hand hygiene improvement strategy. Limitations of the study The survey was targeted at individuals having a health-care encounter as a patient. However, distribution channels (<strong>WHO</strong> Patients for Patient Safety Champions and members of the International Alliance of Patient Organizations) inevitably resulted in sample bias with a high percentage of respondents being both patients and also involved in some way in the health-care sector, which limits the capacity for generalizing these results to the population as a whole. It is probable also that respondents were sensitized to the issues surrounding HCAI during the survey and replied to certain questions in a manner that might be considered as a socially acceptable response. Although limited, the number of responses from the African, South-East Asia, Eastern Mediterranean, and Western Pacific Regions are useful for comparative purposes, and further work will be required in the future to gain a greater understanding of patient perception in these regions. 1 Patient empowerment (pilot web site). London, National Patient Safety Agency, 2008 (http://www.npsa.nhs.uk/cleanyourhands/in-hospitals/pep/, accessed 1 December 2008) 2 Zorzi R. Evaluation of a pilot test of the provincial hand hygiene improvement program for hospitals - final report. Toronto, Cathexis Consulting Inc., 2007. 3 McGuckin M, Waterman R, Shubin A. Consumer attitudes about health care-acquired infections and hand hygiene. American Journal of Medical Quality, 2006, 21:342-346. 4 Aleccia J. The dirty truth about docs who don’t wash: Patients shouldn’t be shy about asking providers to hit the sink, experts say. Microsoft web site, Health page, 2008 (http://www.msnbc.msn.com/id/22827499, accessed 26 November 2008). 257
<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE ABBREVIATIONS AFFF AFR<strong>WHO</strong> AFRO AIDS AMR AMRO ASTM BSI CBA CCM CDC CEA CEN CEO CFU CHG CMCH CoNS CR-BSI CR-UTI CTICU CTS DALY DDAC EA EDTA EMR EMRO EN / prEN ESBL EUR EURO FDA GPPHWS HACCP HARMONY HAV HBM HBV HCAI HCP HCW HELICS HICPAC HIV HLC HNN HSV ICER ICU IHI aqueous (water) film-forming foam African Region <strong>WHO</strong> Regional office for Africa acquired immunodeficiency syndrome <strong>WHO</strong> Region of the Americas <strong>WHO</strong> Regional office for the Americas American Society for Testing and Materials bloodstream infection cost–benefit analyses Centro per il Controllo delle Malattie Centers for Disease Control and Prevention cost–effectiveness analyses Comité Européen de Normalisation / European Committee for Standardization chief executive officer colony forming unit chlorhexidine gluconate Chittagong Medical College Hospital coagulase-negative staphylococci cather-related bloodstream infection catheter-related urinary tract infection cardiothoracic intensive care unit complementary test site disability-adjusted life year didecyldimethyl ammonium chloride ethanol ethylene-diaminetetraacetic acid <strong>WHO</strong> Eastern Mediterranean Region <strong>WHO</strong> Regional Office for the Eastern Mediterranean European norm / European norm in preparation (prenorm) extended-spectrum beta-lactamase <strong>WHO</strong> European Region <strong>WHO</strong> Regional Office for Europe Food and Drug Administration Global Public Private Partnership for Handwashing with Soap hazard analysis critical control point Harmonisation of Antibiotic Resistance measurement, Methods of typing Organisms and ways of using these and other tools to increase the effectiveness of Nosocomical infection control hepatitis A virus Health Belief Model hepatitis B virus health care-associated infection hexachlorophene soap/detergent health-care worker Hospital in Europe Link for Infection Control through Surveillance Healthcare Infection Control Practices Advisory Committee human immunodeficiency virus Health Locus of Control Hospital Nacional de Niños herpes simplex virus incremental cost–effectiveness ratio intensive care unit Institute for Healthcare Improvement INICC IPA IPA-H JCAHO JHPIEGO KAAMC LR MDG MIC MICU MRSA MSICU NHS NICE NICU NIH NIOSHA NNIS n-P NPSA OPD PACU PAHO PASA PCMX PDSA P-I PICU PMT PPE QAC QALY REP RNAO RSV SARS SEAR SEARO SEM SICU SSI TFM TPB USA USAID UTI VAP VRE v/v <strong>WHO</strong> WPR WPRO International Nosocomial Infection Control Consortium isopropanol isopropanol + humectants Joint Commission on Accreditation of Healthcare Organizations Johns Hopkins Program for International Education on Gynecology and Obstetrics (international health organization affiliated to Johns Hopkins University) King Abdul Aziz Medical Center log reduction Millennium Development Goal minimum inhibitory concentration medical intensive care unit methicillin-resistant Staphylococcus aureus medical/surgical intensive care unit National Health Service National Institute for Health and Clinical Excellence neonatal intensive care unit National Institutes of Health National Institute for Occupational Safety and Health Administration National Nosocomial Infection Surveillance n-propanol National Patient Safety Agency outpatient department post-anaesthesia care unit Pan American Health Organization Purchasing and Supply Agency para-chloro-meta-xylenol Plan–Do–Study–Act povidone-iodine detergent paediatric intensive care unit Protection Motivation Theory Personal Protective Equipment quaternary ammonium compound quality-adjusted life year Replicating Effective Programs Registered Nurses Association of Ontario respiratory syncytial virus severe acute respiratory syndrome <strong>WHO</strong> South-East Asia Region <strong>WHO</strong> Regional Office for South-East Asia Self-efficacy Model surgical intensive care unit surgical site infection Tentative Final Monograph Theory of Planned Behaviour United States of America United States Agency for International Development urinary tract infection ventilator-associated pneumonia vancomycin-resistant enterococci volume/volume World Health Organization <strong>WHO</strong> Western Pacific Region <strong>WHO</strong> Regional Office for the Western Pacific 258
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