Four Moments for Patient Hand Hygiene: A Patient-Centered, Provider-Facilitated Model to Improve Patient Hand Hygiene

Sunkesula, Venkata; Knighton, Shanina C.; Zabarsky, Trina F.; Kundrapu, Sirisha; Higgins, Patricia A.; Donskey, Curtis J.

doi:10.1017/ice.2015.78

Cited by 29 publications

(33 citation statements)

References 6 publications

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“…Before these interventions, it was surmised that hand hygiene was simply overlooked by nursing staff, as reported by Fox et al 4 The essential times for hand hygiene used in this project were corroborated by Sunkesula et al 5 as being before meals, after using the restroom, before contact with incisions or wounds, and before leaving and after returning to the hospital room.…”

Section: Relation To Other Evidencementioning

confidence: 59%

Patients’ Hand Washing and Reducing Hospital-Acquired Infection

Haverstick

Goodrich

Freeman

et al. 2017

Critical Care Nurse

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BACKGROUND Hand hygiene is important to prevent hospital-acquired infections. Patients’ hand hygiene is just as important as hospital workers’ hand hygiene. Hospital-acquired infection rates remain a concern across health centers. OBJECTIVES To improve patients’ hand hygiene through the promotion and use of hand washing with soap and water, hand sanitizer, or both and improve patients’ education to reduce hospital-acquired infections. METHODS In August 2013, patients in a cardiothoracic postsurgical step-down unit were provided with individual bottles of hand sanitizer. Nurses and nursing technicians provided hand hygiene education to each patient. Patients completed a 6-question survey before the intervention, at hospital discharge and 1, 2, and 3 months after the intervention. Hospital-acquired infection data were tracked monthly by infection prevention staff. RESULTS Significant correlations were found between hand hygiene and rates of infection with vancomycin-resistant enterococci (P = .003) and methicillin-resistant Staphylococcus aureus (P = .01) after the intervention. After the implementation of hand hygiene interventions, rates of both infections declined significantly and patients reported more staff offering opportunities for and encouraging hand hygiene. CONCLUSION This quality improvement project demonstrates that increased hand hygiene compliance by patients can influence infection rates in an adult cardiothoracic step-down unit. The decreased infection rates and increased compliance with hand hygiene among the patients may be attributed to the implementation of patient education and the increased accessibility and use of hand sanitizer.

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Section: Relation To Other Evidencementioning

confidence: 59%

Patients’ Hand Washing and Reducing Hospital-Acquired Infection

Haverstick

Goodrich

Freeman

et al. 2017

Critical Care Nurse

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“…To reduce the need for self-regulation, hospitals could change the environment to nudge people to clean their hands when necessary. For instance, placing dispensers at highly visible and easily accessible locations (14,(54)(55)(56) and installing reminders (12,(57)(58)(59)(60). Another option would be to implement more control and monitoring tools (e.g., personnel making sure that patients clean their hands before eating (61)).…”

Section: Summary Goal Two: Identifying Critical Determinantsmentioning

confidence: 99%

“…Information material, signs, and other reminders should include normative messages to highlight laypeople's role within the facility's infection prevention strategy (12,57,60).…”

Section: Summary Goal Two: Identifying Critical Determinantsmentioning

confidence: 99%

“…One reason for the de ciency of research on laypeople's hand hygiene could be the lack of universally valid guidelines that indicate when these people should sanitize their hands in healthcare facilities (11). Four critical moments for patients have been proposed: (a) before and after touching wounds/devices; (b) before eating; (c) after using the restroom; and (d) when entering or leaving the patient room (12). Other scholars suggested a more comprehensive list with nine moments for patients' hand hygiene, which also included "after coughing, sneezing, or touching nose or mouth" and "before and after interacting with visitors" (11).…”

Section: Introductionmentioning

confidence: 99%

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Hand(y) Hygiene Insights: Applying Three Theoretical Models to Investigate Hospital Patients’ and Visitors’ Hand Hygiene Behavior

Gaube

Fischer

Lermer

2020

Preprint

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BackgroundImproving hand hygiene is the most efficient method to prevent healthcare-associated infections, which are a severe threat to patient safety. Besides healthcare professionals, it is mainly hospital patients and visitors who pose a risk for the transmission of pathogens, which can lead to infections. In contrast to medical staff, laypeople’s hand hygiene behavior in hospitals is not well researched. Therefore, the present study had three aims: 1) Identifying a suitable theoretical model to explain laypeople's hand hygiene practice; 2) Finding the factors that strongly affect patients’ and visitors’ hand hygiene behavior and, therefore, should be targeted in behavior change interventions; and 3) Comparing the essential determinants of hand hygiene behavior between laypeople and healthcare professionals.MethodsTo accomplish these goals, in total N = 1,605 patients and visitors were surveyed on their hand hygiene practice in hospitals. The employed questionnaires were based on three theoretical models: a) the Theory of Planned Behavior (TPB); b) the Health Action Process Approach (HAPA); and c) the Theoretical Domains Framework (TDF). Structural equation modeling (SEM) was used to analyze the data.ResultsAmong patients, 53% of the variance in the hand hygiene behavior was accounted for by the TDF domains, 44% by a modified HAPA model, and 40% by the TPB factors. Among visitors, these figures were 60%, 37%, and 55%, respectively. Two clusters of variables surfaced as being essential determinants of the behavior: First, self-regulatory processes (perceived behavioral control; action control; memory, attention, and decision processes); and second, social influence processes (subjective norm and role and identity).ConclusionsThe TDF was identified as the most suitable model to investigate and predict patient’s and visitor’s hand hygiene practices. The critical determinants for adequate hand hygiene (i.e., self-regulation processes and social influence processes) are similar for laypeople and healthcare professionals. Therefore, analogous intervention strategies might be useful for both target groups. Further practical and theoretical implications are discussed.

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“…In previous studies, patients in our facility often were unaware of the bottle of hand sanitizer or rarely used it owing to lack of instruction. 4,6,10 All patients were screened for methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage on admission and at discharge.…”

Section: Methodsmentioning

confidence: 99%

A pilot study to assess the impact of an educational patient hand hygiene intervention on acquisition of colonization with health care–associated pathogens

Rai

Saldana

Gonzalez-Orta

et al. 2019

American Journal of Infection Control

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Patient hand hygiene is a commonsense measure that has been associated with reductions in colonization or infection with bacterial and viral pathogens in quasi-experimental studies. We conducted a nonblinded pilot randomized trial to assess the impact of an educational patient hand hygiene intervention on acquisition of colonization by selected health care-associated pathogens in hospitalized patients. For patients with negative admission cultures, the intervention did not reduce the new acquisition of colonization by pathogens compared with that of standard care.

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Four Moments for Patient Hand Hygiene: A Patient-Centered, Provider-Facilitated Model to Improve Patient Hand Hygiene

Cited by 29 publications

References 6 publications

Patients’ Hand Washing and Reducing Hospital-Acquired Infection

Patients’ Hand Washing and Reducing Hospital-Acquired Infection

Hand(y) Hygiene Insights: Applying Three Theoretical Models to Investigate Hospital Patients’ and Visitors’ Hand Hygiene Behavior

A pilot study to assess the impact of an educational patient hand hygiene intervention on acquisition of colonization with health care–associated pathogens

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