Patient motivational dialogue: A novel approach to improve hand hygiene through patient empowerment in ambulatory care

doi:10.1016/j.ajic.2019.11.024

American Journal of Infection Control

Volume 48, Issue 5, May 2020, Pages 573-574

https://doi.org/10.1016/j.ajic.2019.11.024 Get rights and content

Highlights

•
Providers should encourage patients to ask others to clean their hands.
•
Providers should respond positively when patients ask them to clean their hands.
•
Hand hygiene prior to donning gloves should be included in healthcare education.

A novel patient empowerment strategy called Patient Motivational Dialogue purposed to improve hand hygiene compliance is described. Two barriers to sustainability of patients asking health care providers (HCP) to clean their hands were noted in this study: (1) the HCP responding negatively to the patient asking, and (2) the patient misunderstanding that wearing gloves does not replace hand hygiene. Both barriers may be addressed through education of HCP and of consumer.

Section snippets

Methods

The setting was an ambulatory center. All patients including children with consenting parents enrolled in one of two clinics were eligible for study enrollment. Participants’ knowledge and beliefs were compared pre- and postintervention using a nominal scale survey developed by infection prevention experts. The PMD was provided by the primary HCP during the initial visit, and for three consecutive visits thereafter to strengthen the dose. After clinic discharge, the investigator interviewed the

Results

Forty-one patients completed the study. The average age was 54 years (SD, 19.8). There were more women (76%), more Hispanics (59%), and >70% with a high school education or less.

Table 2 lists the differences in pre- and postintervention responses on the HH survey. There were no significant differences except on Question #1: Have you ever asked your doctor or nurse to clean their hands? There was a 66% absolute improvement in participants asking their HCP to clean their hands at least 1 time

Discussion

The study suggests that using a motivational strategy, PMD, in the health care partnership to empower patients to ask HCPs to clean their hands is a promising intervention. A strength of this study is teaching HH as a part of the treatment plan to the patient in the ambulatory care setting where the patient is not as acutely ill as in the hospital.

An interesting area that surfaced in the study is participants exhibiting a lack of knowledge about the importance of HH before donning gloves. This

Conclusions

This study adds to the literature on patients advocacy for HH, providing insight to the implementation of a patient empowerment strategy in an ambulatory setting. Two components of the PMD may have impacted patient advocacy for HH: (1) patients responded positively to the PMD when the importance of HH was presented as an essential component of the treatment plan through dialogue with the primary HCP; and (2) patients reported being intimidated by HCPs across the continuum of care when they

References (7)

K Arise et al.
Continued direct observation and feedback of hand hygiene adherence can result in long-term improvement
Am J Infect Control
(2016)
HJ Seo et al.
Interventions to improve hand hygiene compliance in emergency departments: a systematic review
J Hosp Infect
(2019)
M McGuckin et al.
Patient empowerment and hand hygiene, 1997-2012
J Hosp Infect
(2013)

There are more references available in the full text version of this article.

Cited by (7)

Implementation of a quality improvement project using the patient as the observer to improve hand hygiene compliance in ambulatory care practices
2023, Journal of Hospital Infection
Monitoring hand hygiene compliance in the ambulatory setting remains a challenge because a healthcare trained observer loses line of sight once the examination room door closes. This quality improvement project focused on the implementation of a hand hygiene compliance improvement programme that is amenable to the routines and work flows of the ambulatory setting.
After a review of the literature, nursing leadership and infection prevention implemented the ‘patient as the observer’ hand hygiene programme across 32 ambulatory practices.
Patients completed 281,000 observations with an overall compliance rate of ≥90%. The average overall compliance rate by role was 91% for providers, 89% for nurses, and 91% for medical assistants/technicians/others. A 92% compliance average was noted ‘before caring for you’ and 89% ‘after caring for you’ for providers, 90% and 87% for nurses, and 92% and 89% for medical assistants/technicians/others.
This study demonstrated that the implementation of a hand hygiene compliance improvement programme using the patient as the observer can be adopted successfully in the ambulatory setting.
Hand hygiene compliance can be monitored effectively in the ambulatory setting with the involvement of the patient as the observer.
Patient participation in its own safety
2021, Atencion Primaria
El enfoque de atención centrada en el paciente y los avances normativos desarrollados en los últimos años han promovido la implicación del paciente en la toma de decisiones sobre pruebas diagnósticas y tratamientos. En otros aspectos, como la participación en su seguridad, aún queda mucho por hacer.
Hasta hace poco tiempo se ha considerado al paciente como mero receptor de los servicios sanitarios, no como parte activa del sistema, ni mucho menos como barrera de seguridad frente a los fallos y errores que acontecen durante la asistencia.
Algunos pacientes se han activado con base en sus experiencias. Pero muchos otros no. Por eso es necesario sensibilizar, informar y formar al paciente de forma proactiva para que participe en su seguridad.
No se trata de traspasarle la responsabilidad, sino de facilitar y promover su participación reforzando su seguridad durante el proceso asistencial. El sistema sanitario debe estar comprometido, y el paciente informado y formado.
Aportamos herramientas y recursos online para su aplicación en atención primaria.
Patient-centered approach to care and regulatory advances developed in recent years have promoted patient involvement in decision-making about diagnostic tests and treatments. In other aspects, such as participating in their own safety, there is still a lot to do.
Until recently, the patient has been considered as a simple health services receiver, not as an active part of the system, much less as a safety barrier against failures and errors that occur in health care.
Some patients have been activated thanks to their experiences. However, many others do not. That is why it is necessary to proactively sensitize, inform and train patients to participate in their own safety. It is not about holding them responsible, but about facilitating and promoting their participation by reinforcing their safety during the care process. The health system must be committed, and the patient informed and trained.
We provide tools and online resources to apply in primary care.
Evaluating the effect of automated hand hygiene technology on compliance and C. difficile rates in a long-term acute care hospital
2021, American Journal of Infection Control
Citation Excerpt :
Patient involvement incorporated into the implementation process provided an additional element of shared HH compliance. Studies on the importance of patient involvement continue to reinforce the role of patients in HH compliance efforts.26-30 The ability of HH technology to identify specific HCW categories provides an opportunity to examine outcomes beyond HH compliance.
Compliance with hand hygiene (HH) standards is a critical component to reducing the prevalence of Health Care Acquired Infections (HAIs). The use of HH technologies is increasing and studies examining the success of these technologies on HH compliance and HAIs are important to inform standards of care. COVID-19 has emphasized compliance HH standards.
This study evaluated HH compliance and Clostridium difficile (C difficile) rates following implementation of an HH technology at a long-term acute care hospital. The HH technology required nursing and other staff with direct patient contact to wear a “badge” that measured alcohol concentration on a health care worker's hands or time washing hands at designated sinks upon exit/entry of patient rooms. No changes were made to environmental cleaning or antibiotic stewardship standards. Compliance and infection rates were compared 12 months pre–post implementation during 2017-2019.
There was an increase in HH compliance (89.82%-97.10%, P< .001)) and a reduction in the incidence of C. difficile (9.541-3.720, P= .0032).
The HH technology significantly and quickly increased HH compliance and reduced rates of C difficile. The technology provided ancillary benefits, including data tracing of all patient and staff contacts and cross-contamination events.
SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update
2023, Infection Control and Hospital Epidemiology
Using consumer engagement strategies to improve healthcare safety for young people: An exploration of the relevance and suitability of current approaches
2022, Health Expectations
Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety
2021, Health Expectations

View all citing articles on Scopus

: Funding/support: This work was funded by the University of Texas System Patient Safety Committee (2016-2018) UT Health San Antonio Institutional Review Board Protocol Number: HSC20160369H.

: Conflicts of interest: None to report.

View full text

Brief ReportPatient motivational dialogue: A novel approach to improve hand hygiene through patient empowerment in ambulatory care