Research for infection protection

Safety in the patients’ hands: Patient empowerment in hand hygiene

Many patients wish that their physicians would actively involve them in therapy decisions. And many physicians comply with this wish with the approach of a shared decision-making (SDM). In this approach, physicians and patients take any decision on the medical therapy jointly and as equal partners. Precondition for this is a fundamental understanding of the own health: today—thanks to Google, medical forums, etc.—the “empowered patient” is more competent than ever. But to anticipate fears and misinformation it is reasonable to establish a targeted patient empowerment in the medical field: when physicians, health organisations and medical facilities provide their patients with selected and well-founded information, they promote their health competence and ensure enlightened decisions.

Targeted information can reduce fears

The added value of patient empowerment is not limited to the decisions on therapy and treatment—also in hand hygiene, active patient empowerment is a useful addition for patient protection and infection control. The reason: without any doubt, hand hygiene is the most important measure to prevent nosocomial infection. However, educational campaigns and training courses mainly address healthcare workers. But topics such as prevention and protection against infections increasingly attract the attention of patients as well: according to a survey, two of three Germans are afraid of acquiring a multidrug-resistant pathogen during their hospital stay [1]. To involve patients in hand hygiene in a targeted manner can help assess risks of infection in the hospital more realistically and overcome irrational fears of multidrug-resistant microorganisms. However, efficient patient empowerment in hand hygiene also informs patients of the role they play in infection control—and thus encourages them to become active.

Patients are hardly aware of the importance of the own hand hygiene

Many patients are not sufficiently aware of the fact that they can actively participate in hand hygiene and thus protect themselves and others against infection. Scientific observations prove this, too [2]: while 85 % of the patients state that they disinfect or wash their hands after having used the toilet at home, only 70 % of the respondents do so in the hospital. This trend is even more obvious when it comes to hand hygiene measures before eating: when at home, around 65 % of the patients wash or disinfect their hands before meals—in the hospital, this share drops to approx. 41 %.
Here, targeted information attuned to patients can help raise awareness of the own hand hygiene in the hospital and particularly motivate patients to perform hand disinfection in certain moments.

Patients need active confirmation in hand hygiene

To learn more about hand hygiene patients especially wish to be directly encouraged by staff (80.8 %) and want visual reminders, e.g. posters (73.4 %) [2]. When speaking with patients it is important to minimise fears and inspire personal initiative. Example: knowing that bacteria do not develop in hospitals but are naturally present in the environment and even are a vital part on the own intestinal and skin flora helps patients. And the hint that they are allowed to use the disinfectant dispensers installed in the hospital additionally helps overcome potential inhibitions and can promote the hand hygiene behaviour of patients and visitors.

Hand hygiene especially for patients: The right timing

The moments when patients and visitors should disinfect their hands are derived from the recommendations of the World Health Organization (WHO) and the German Robert Koch-Institute (RKI) [3, 4]:

  • When entering or leaving the patient room
  • After having used the toilet or the bedpan
  • Before eating, drinking and taking medication
  • Before and after contact with own wounds, mucous membranes or venous accesses
  • After contact with high-touch surfaces in the hospital (e.g. door handles, handrails)

1. Representative survey of the hospital corporation Asklepios among 1,000 German citizens on the occasion of the first International Patients Safety Day on 17 September 2015:
2. Barker, A. et al. Patient’s Hand Hygiene at Home Predicts Their Hand Hygiene Practices in the Hospital. Infect Control Hosp Epidemiol, 2014, 35(5):585-588.
3. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. 2, Patient empowerment and health care.
4. Händehygiene in Einrichtungen des Gesundheitswesens – Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsbl, 2016, 59:1189–1220.