Strategies for Patient Empowerment and Hand Hygiene Compliance

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In conjunction with the recently published World Health Organization (WHO) Guidelines for Hand Hygiene, members of the Clean Care is Safe Care task force undertook a review of the evidence for implementing a successful patient empowerment/healthcare worker (HCW) empowerment program for hand hygiene compliance improvement in the January/February 2011 issue of the American Journal of Medical Quality, released Epub ahead of print June 2010.

Based on 11 years of research and more than 133 papers and abstracts, evidence suggests that successful empowerment programs, which also may be referred to as patient participation or patient involvement programs, contribute to an overall successful hand hygiene compliance program, and can be considered a "win-win strategy" as the article title suggests.(1)

According to the research, successful patient and HCW empowerment programs are usually part of a multimodal approach to education and monitoring, and include at least one of the following elements: educational tools, motivation tools, and role modeling. They also include having the HCW give explicit permission to the patient to remind the HCW about hand hygiene.

The WHO team reminds infection prevention colleagues that empowerment does not always translate across cultures easily. Certain cultural norms about healthcare and authority, as well as norms on perceived gender roles, religion, and age, all impact a patients willingness to remind their HCW to perform hand hygiene. The same factors impact a HCWs willingness to embrace the patient participation concept. Additional strategies are shared in the WHOs Guidelines for Hand Hygiene published in 2009.(2)


WHO has found documented efforts for patient empowerment programs in countries such as Australia, Belgium, Canada (in Ontario), the UK (in England, Wales, and Northern Ireland), Ireland, Italy, Norway, Canada, and Saudi Arabia. The authors encourage further research and implementation in these countries as well as countries from other world regions, to further document newly discovered success strategies with patient and HCW empowerment.

Recent examples of patient empowerment research include the work conducted by Dr. Maryanne McGuckin and colleagues to promote empowerment programs as part of the hand hygiene compliance education during the last decade which have reported increase in compliance when empowerment is implemented. They reported on hundreds of hospitals from the U.S. that monitored monthly hand hygiene rates based on common methodology for data collection and education. Patient empowerment, including HCWs instructing patients to offer reminders (or thanked their HCWs) for performing hand hygiene, has been proven to improve compliance by more than 40 percent over original scores in ICUs and non-ICUs.(3)

Most recently, Dr. Yves Longtin and colleagues at Geneva University Hospital have shown that although HCWs reported several barriers to patient participation, 58 percent of the same HCWs surveyed agreed that patient participation would in fact improve hand hygiene.(4)


1. McGuckin M, Storr J, Longtin Y, et al. Patient Empowerment and Multimodal Hand Hygiene Promotion: A Win-Win Strategy. Am J Med Qual. Epub ahead of print on June 24, 2010. Doi:10.1177/1062860610373138. Accessed online at:

2. World Health Organization. Guidelines for Hand Hygiene. 2009. Available at:

3. McGuckin M, Waterman R, Govednik J. Hand Hygiene Compliance Rates in U.S. A One-Year Multicenter Collaborative Using Product/Volume Usage Measurement and Feedback. Am J Med Qual. 24 (3) 205-213. DOI: 10.1177/1062860609332369

4. Longtin Y, Farquet N, Gayet-Ageron A, Pittet D. Healthcare Workers Beliefs and Perceptions Regarding Patient Participation to Increase Staff Compliance with Hand Hygiene. Presented at the 2010 Interscience Conference on Antimicrobial Agents and Chemotherapy. Sept. 2010. Available at: