WHO Encourages Patient Participation in Hand Hygiene

On Hand Hygiene Day, May 5, the World Health Organization (WHO) is encouraging patients and their family members to join healthcare workers in their efforts to practice good hand hygiene. Every year, hundreds of millions of patients around the world are affected by healthcare-associated infections. These lead to significant physical and psychological suffering and sometimes death of patients, and financial losses for health systems. More than half of these infections could be prevented by caregivers properly cleaning their hands at key moments in patient care.

Healthcare-associated infections usually occur when germs are transferred by healthcare providers hands touching the patient. The most common infections are urinary tract and surgical site infections, pneumonia and infections of the bloodstream. Of every 100 hospitalized patients, at least 7 in developed and 10 in developing countries will acquire a healthcare-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100.

Practicing good hand hygiene during healthcare by using alcohol-based hand rubs or washing hands with soap and water if visibly dirty reduces the risk of these infections.

"Healthcare-associated infections are a major burden around the world and threaten the safety and care of patients, says Sir Liam Donaldson, WHO Envoy for Patient Safety and former chief medical officer for England. I urge the health care and patient communities to take firm and decisive action to save lives from this preventable harm.

More than 15 700 healthcare facilities with more than 9 million healthcare workers in 168 countries have registered their commitment to good hand hygiene as part of the WHO global campaign: SAVE LIVES: Clean Your Hands. The campaign has been running since 2009 and 12 new countries joined in the last year.

According to the WHO Clean Care is Safer Care Program, when working with patients, hand hygiene should be performed at five key moments, preferably by using an alcohol-based rub or by handwashing with soap and water if hands are visibly dirty. The five moments for hand hygiene are:
1. before touching a patient
2. before clean and aseptic procedures (e.g., inserting devices such as catheters)
3. after contact with body fluids
4. after touching a patient
5. after touching patient surroundings
Generating public awareness and patient participation are key to enhancing opportunities for patient safety. Many health facilities educate and encourage patients and their families to participate in hand hygiene. According to a new survey conducted by WHO and its Collaborating Centre on Patient Safety, the University of Geneva Hospitals, patient participation is considered a useful strategy for improving hand hygiene and creating a positive patient safety climate in the facilities implementing it.

Patient participation can be a powerful tool to achieve improvements in health care, says Dr. Benedetta Allegranzi, team lead in the WHO Patient Safety Clean Care is Safer Care programme. Although the ability of patients to be involved will vary in different cultures and situations, family members of patients often help with caregiving and they are some of the best advocates for their loved ones. That makes them good allies in this process.

Patients and their family members can participate by:
- asking for information about any existing initiatives that involve patients at the healthcare facility
- asking healthcare workers who are about to touch them to clean their hands, and thanking them when they do.
To be successful, activities to empower patients should ensure the buy-in of health workers and respect the local culture, says Didier Pittet, lead advisor to WHOs Clean Care is Safer Care programme and director of infection control at the University of Geneva Hospitals.
On and around May 5 this year, WHO also invites healthcare facilities to take action on monitoring hand hygiene practices and providing feedback to healthcare workers. These are essential elements of successful strategies to reduce healthcare-associated infections.

The WHO Guidelines on Hand Hygiene in Health Care (2009) encourage partnership between patients, their families, and healthcare workers to promote hand hygiene in healthcare settings. Patient participation/engagement/empowerment in hand hygiene promotion refers to the involvement of patients in the fostering of hand hygiene best practices by both patients and health-care workers in healthcare settings.
The goals are:
- To implement a true safety culture in which both patients, (and their relatives and visitors) and healthcare workers work together toward strengthening infection prevention and control and promoting hand hygiene best practices.
- While the responsibility for hand hygiene rests firmly with the healthcare worker, to encourage patients to support healthcare workers in improving hand hygiene in various ways, such as learning about hand hygiene best practices and reminding or evaluating hand hygiene.
- The ultimate goal is to improve hand hygiene and prevent health care-associated infections.
According to a new survey conducted by WHO and its Collaborating Centre on Patient Safety, the University of Geneva Hospitals, in 260 facilities from 41 countries, patient participation is perceived as a useful strategy contributing to hand hygiene improvement among healthcare workers and to the creation of a positive patient safety climate in the facilities implementing it.

To make it happen in your healthcare facility you can:
- Empower patients and their family and visitors to proactively help to ensure that hand hygiene is performed at the right times and in the right way, guided always by the patients willingness to participate.
- Engage patient organizations to assist with patient advocacy or education, or to lobby for funding and/or improved facilities.
- Secure the full support of institutional leaders (e.g. hospital director, CEO, senior nurse) in pursuing patient engagement and empowerment if this is considered appropriate.
- Focus on activity designed to ensure buy-in of health-care workers to support greater engagement and empowerment of patients in hand hygiene improvement.
Critical issues to address:
- Patient engagement endeavours must fit within a broader, global hand hygiene promotion framework.
- Patients can be empowered only after having gathered enough information, understood how to use the information, and being convinced that this knowledge gives them the opportunity, and the right, to participate in helping to keep healthcare safe while not deflecting the responsibility away from their healthcare workers.
- Patients are more likely to participate if they feel authorized and supported to do so by their healthcare workers. As a consequence, the successful set-up of a patient empowerment strategy requires the full support of healthcare workers across all levels of the organization. Information sessions may be required to reassure healthcare workers as to the goals of the strategy, i.e., reduction of harm to patients, and to win their full support.
- Facilities may also consider collaborating with an independent third-party patient organization. Patient organizations can help to reach patients, healthcare providers and the wider public, helping to build a safety climate.

Source: WHO