Clinicians resist patient scolding about hand hygiene

Despite calls for better hand hygiene, about a third of doctors and nurses don't like the idea of patients reminding providers to wash their hands, according to a study in the Archives of Internal Medicine this week.

Although most (about three quarters of the surveyed physicians and nurses at University of Geneva Hospitals) acknowledged patient involvement could help reduce infections, 29 percent did not support the idea that patients remind them to wash their hands, HealthDay News reported. Twenty-seven percent went so far as to say it's not the patient's place to do so. Even more, 37 percent of healthcare workers said they would refuse to wear a badge that would solicit patient inquiries on the issue.

Amid threats of more in-hospital antibiotic-resistant infections, why are staff so resistant to patient involvement in hand hygiene?

While the doctors and nurses reported some logistical reasons for why patients shouldn't ask about hand hygiene, they also reported it would hurt their feelings: 17 percent said it would be upsetting, 27 percent said humiliating, 43 percent said guilty and 44 percent would feel ashamed. About a quarter said it would take too much time, and 18 percent feared legal ramifications.

"Healthcare workers have feelings, too, and patients have to be receptive to them," Yves Longtin, who conducted the research with the Infection Control Program and World Health Organization Collaborating Centre on Patient Safety at the University of Geneva Hospitals, said in the HealthDay News article.

Still, hurt feelings may not be a good enough reason to let poor hand hygiene slide.

"I personally think it's foolish and myopic for any healthcare worker to be offended by a patient asking this sort of question," said Philip Tierno, a clinical professor of microbiology and pathology in the department of pathology at NYU Langone Medical Center. "Patients have that right, and they are justified in asking."

Researchers noted that although the hospital had a history of promoting hand hygiene among staff, it didn't have a formal program on patient participation. In the month leading up to the survey, only 3 percent of clinicians said a patient asked them about hand hygiene.

However, a separate study found that staff also may remain silent on the issue. Eighty-three percent of medical students said they are unwilling to speak up to senior staff about subpar hand-hygiene practices, according to a survey conducted by researchers at the Monash University in Melbourne (AU) earlier this summer, Infection Control Today reported. A key factor that prevents students from speaking up is the fear of questioning senior staff, but disrupting the hierarchal culture in healthcare should not affect the quality of patient care, researchers said.

Sentara Healthcare, a nonprofit health system serving Virginia and North Carolina, welcomes patients to act as hand-hygiene monitors. Nurses initiate those conversations with patients, encouraging them to remind providers to wash their hands if they forget, and also leave handwritten notes (e.g., "I love clean hands!") on white boards as reminders.

"Everyone is [responsible] because it requires a culture change to place safety ahead of production," Gene Burke, Sentara vice president and executive medical director of clinical effectiveness, previously told FierceHealthcare. "Hand hygiene throughout the facility is just as important as scrubbing in for the OR," he explained.

Hospital-acquired infections account for about 100,000 deaths in the United States every year, and 80 percent of all infectious disease is transmitted by direct contact, according to Tierno.

For more information:
- read the HealthDay News article
- see the Infection Control Today article
- check out the FierceHealthcare special report

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