Cleanyourhands Campaign

Patient Empowerment Programme

Steering Group

Held at NPSA Offices, London

7th September 2007


Vivienne Allan, Head of Strategic Communications, NPSA

Derek Butler, Chair, MRSA Action UK

Martin Fletcher, Chief Executive, National Patient Safety Agency (NPSA)

Emma Forbes, Cleanyourhands project manager, NPSA

Tracey Gauci, Nursing Officer for Communicable Disease, Welsh Assembly Government

Felix Greaves, Department of Health

Dr Yves Longtin, Infection Control Programme, University of Geneva Hospitals

Peter Mansell, Director of Patient Experience, NPSA

Dr Maryanne McGuckin, Health Service Researcher and Educator, University of Pennsylvania

Professor Didier Pittet, Director, Infection Control Program, The University of Geneva Hospital and Lead Global Patient Safety Challenge, WHO World Alliance for Patient Safety

Claire Stebbing, Special Advisor to the Chief Medical Officer, Department of Health

Julie Storr, Project Manager, Global Patient Safety Challenge, WHO World Alliance for Patient Safety

Janice Stevens, Director, MRSA/Cleaner Hospital Team, Department of Health (England)

Paul Weaving, Safer Practice Lead for Infection Control, NPSA and Infection Control Nurse Lead, Cumbria Primary Care Trust

Katherine Wilson, Cleanyourhands campaign lead, NPSA


Suzette Woodward, Strategic Advisor, NPSA

Katherine Murphy, Patients Association


MRSA Action UK were invited to put the patients' perspective on the Chief Medical Officer's initiatives to improve compliance with hand hygiene and the Patient Empowerment Programme.


The meeting was arranged to discuss the next steps forward in the Cleanyourhands Campaign and the planning needed to take forward the Patient Empowerment Programme and its viability.


There were many presentations given by some of those attending the meeting, looking at studies done in the area of patient participation.  One of the most surprising aspects in the patient participation studies is that there is evidence to show that this research has been ongoing since the 1980s, so the studies are quite extensive.


On viewing the studies it would seem that patients do want to participate in certain areas of their medical care.  Two of the main areas of patient participation is when choosing treatments and end-of-life issues.  It was also found from these studies that the family members of these patients also wanted to participate mainly in those two areas.


Some of the obstacles that were noted from the studies was that a lack of knowledge hindered patient participation, and it was found that if the patient had the information explained to them they gained in confidence and wanted to participate.  The provision of information to the patient was more easily available when the doctors explained fully the choice of treatments and the differing outcomes.


Some of the other obstacles were demographic and it came down to two factors influencing the desire to participate more or less.  The first factor was age, it was found that in Europe the older age groups tended to participate less and were less inclined to question the medical professional, however in America this was found to be the opposite.  The other most significant factor was gender.  It was found that females are more inclined to participate and question than males in both Europe and America.


It was found that these two factors needed to be looked at and some formula put together to try to increase the participation of those less inclined.  It was also indicated that by having patient participation in healthcare this reduced the errors that were possible in their healthcare.


The studies showed that there were five key elements where information to patients and staff could facilitate improvements, these being:

         System Change

         Training and Education

         Observation and Feedback

         Reminders in the Hospital

         Hospital Safety Climate


Comments were made that whilst patient participation was welcome and indeed necessary there were patients that would be and are unable to participate, and these vulnerable patients had to be protected by the system itself, and that ultimately this came down to the healthcare professionals.  This was unanimously agreed.


The Department of Health gave a presentation concerning the costs to the NHS for healthcare associated infections, estimated at £1 billion. There was only a 60% uptake on hand hygiene within the NHS.  This clearly showed that there was massive scope for improvement both on the uptake of hand hygiene and cost savings to the NHS.


MRSA Action UK raised the issue of added cost to society.  It is well known that many of those that suffer from healthcare associated infections take a longer time to recover and in some instances never recover at all.


It was explained to the DoH representatives that if you factor in this cost of the loss of income to society and the extra expenditure on the benefit system then that £1bn cost is in fact £2bn.  This obvious cost to society shows that by having patient participation in the hand hygiene campaign there will ultimately be cost savings and greater confidence in the NHS.


It was clearly reiterated to all those present from MRSA Action UK that if the public know that there is only a 60% uptake on hand hygiene by healthcare professionals that same public are asking the question, why isn't there 100% compliance from those same people?


The representative from America who was there by a video link actually showed a slide that she had put together in 1982 regarding hand hygiene where she states "patients should be sure that a doctor or nurse has washed their hands before touching them"


Dr Maryanne McGuckin explained quite clearly that we have to empower the healthcare professional as well as the patients and family members, and that it would be much easier to empower patient participation if there was 100% compliance by the healthcare profession.  If the compliance rate is only 60% then the public perception is why should we participate if the professionals who are trained do no wash their hands every time between patients.


Dr McGuckin outlined the problem of the reluctance of some patients to ask doctors or nurses if they have washed their hands.  One initiative that they have introduced is called the reminder card.  Every patient entering the hospital is given this card and when a doctor or a nurse comes to see them the patients ask the doctor or the nurse to read the card.  The first point on the card is "will you please wash your hands".  The other comment that Dr McGuckin made was that patients feel far more reassured if the healthcare professional washes their hands in front of them.  Dr McGuckin still reiterated to those at the meeting that the systems that they had for patient participation did not work for the most vulnerable patients, and therefore it was the responsibility of the healthcare professional to ensure 100% compliance.


There was then a general discussion with Dr McGuckin as to what other elements there were in patient participation and what was important for the patients from the many studies they had done.  Dr McGuckin reported that three subjects concerned patients the most in America:

           Infection rates

           Low infection rates

           High infection rates influenced the patients' choice over which hospital they will use. This is now an obvious driver for the hospitals to reduce their infection rates because the American system allows the patient to choose which hospital they which to be treated in. That is both patient choice and patient participation.


The other comment that Dr McGuckin made was that gloves do not replace hand hygiene, and that the attitude now purveying in America is zero tolerance to infections.  To get this zero tolerance you first require to get the support of the healthcare profession and then the patients and the public.


The final session for discussion was a brainstorming activity which covered:

           How we get patients to participate in asking healthcare workers to wash their hands

           How do we get 100% compliance from healthcare workers

           How we launch the campaign in either a small pilot scheme or as a national campaign covering the whole of the health service


In getting patients to participate it was recognised that there were barriers from the studies that have been done over the past two decades.  Some patients and family members will feel confident to ask healthcare workers to wash their hands, but any system introduced has to take into account those who feel awkward in asking, and those unable to ask.  Some of the suggestions from this session was that a reminder card could be used, reminders could be put onto clothing and bed linen in the hospital, it could be put on night-shirts and pyjamas.  In fact the reminder could be put on anything used within the healthcare setting.


With some of the technology that is available today a prompt light warning could be placed at every bed, so that when a person approaches the bed a light comes on or a warning such as "have you washed your hands" appears.  We have televisions over every hospital bed.  It would not take much to put this system on those televisions, therefore giving the healthcare worker the prompt without the patient asking.


On getting healthcare workers to comply 100% with hand hygiene training and education was the first comment that was mentioned.  There was also the fact that the ideas above would prompt the healthcare worker to sanitise their hands, it was however felt that it is the responsibility of healthcare workers to ensure 100% compliance and that a zero tolerance campaign would be the best way to adopt this approach.


With 100% compliance from medical staff it was considered that the public would be more readily willing to accept their part in infection control.


There was much discussion over how the Patient Empowerment Programme would be launched and the discussion was formed around, is it a pilot scheme, or a full launch throughout the NHS.


The pilot scheme would in fact be very easy to administer and oversee, but this would leave the vast majority of patients outside the Patient Empowerment Programme.  Logistically for supplying every patient with a bottle of alcohol gel and for training and educating the medical staff and the public it would be far easier to see the results over this short and small programme.  A pilot scheme would also show if the programme made any significant improvements in those hospitals participating.


The pilot scheme itself would have to mirror the demographic make-up of the NHS itself.  On a full scale launch of the campaign it was felt that this would give a reflection of any improvements that this system would make, however logistically to supply every patient in the NHS with an alcohol gel would mean producing 18,000,000 bottles (number of hospital episodes).  This equates to 300,000 bottles per week, which then breaks down to an average of 28,000 to 30,000 per day as a minimum.  There was not that number of bottles anywhere in the NHS at the moment.


At the end of the brainstorming session it was asked who, what, where and when?  Would this project be managed for release within the NHS?  It was made quite clear that it would be good for the campaign to be launched as early as October 2007 when the Chief Medical Officer makes an announcement on infection rates.  It was hoped that the whole project, be it either a pilot or national scheme could be launched in October 2007, and a total evaluation, analysis, write-up and review be concluded by the end of May 2008. 


There was some discussion around the issue of do we invite Trusts to apply to be part of the scheme, or should the campaign be aimed at specific Trusts for example those with higher infection rates.


The meeting concluded at 4:15pm and the Chair thanked everyone for their participation and wished everyone a safe journey home.


Derek Butler

Chair MRSA Action UK