March 2009 saw the completion of phase one of the patient empowerment project to design interventions to engage patients in improving the hand hygiene of healthcare staff.

 

Stage two of the campaign will be rolled out in NHS primary care, mental health, ambulance and care trusts.  The steering group considered findings from the research on how effective the campaign had been in readiness for the next stage.  Derek Butler was delighted to be part of the steering group and welcomed the opportunity to give an insight into some of the work in the wider community the Charity had been involved in, including care homes.

 

Professor Didier Pittet, Chair of the Steering Group, asked Catherine Wilson from the NPSA to feedback on responses to questions asking patients if they would ask staff to wash their hands before they treated them.

 

It was evident that 50% of patients would not feel comfortable to ask staff to wash their hands, and this rises to 75% when patients were asked if they had actually asked in a real situation.

 

One of the things this survey showed was that patients were more likely to ask a nurse than a doctor, but the patients main reason for not asking is they assumed healthcare workers had washed their hands, however giving the patients alcohol gel did give some encouragement for them to ask staff to wash their hands.

 

Healthcare workers were asked if they thought by involving patients, it could reduce healthcare infections.  Their answer was yes.  Most healthcare workers were supportive of patients asking them to wash their hands before treating them.  Most hospital trusts have indicated that they involve staff and patients with regard to asking staff to wash their hands.  But patients were not clear about when to use the alcohol gel, and the World Health Organisation 5 moments of contact would help.

 

What is crucial is there must be a dialogue between patient and carer.

 

The Central Office of Information, which is the Government's centre of excellence for marketing and communications, had been commissioned to look at the reasons why there was a low uptake of patients asking staff to wash their hands.  These were some of the barriers cited:

 

A low awareness of healthcare infections

Unawareness of source

A high trust in the hospital environment - it looks clean, it is clean

 

The survey also showed that the concerns for the trends of healthcare infections are low, possibly because there is an image that we are winning the battle.

 

Other findings showed that there was a need to educate patients further about healthcare infections.  This was the how, when, where, who and why?

 

Added to that, patients felt more comfortable being given information about healthcare infections when they were settling in the ward, as this gave them more time to assimilate them into the hospital environment and to read any relevant information.

 

A discussion followed to establish the best ways to encourage patients to ask the staff to wash their hands before treating them and the survey showed clearly patients were nervous asking medical staff this question.  Saying "it's OK to ask" may not be enough because the survey carried out by the COI showed that patients in hospital prefer to be instructed or follow orders. Having the staff inform the patient that they have a right to ask the staff to wash their hands and would encourage them to do so actually raised the percentage of those asking.

 

The discussion moved from patients to staff asking colleagues to wash their hands, and a culture change was now needed.  It was agreed that to have more patient involvement, although some thought this would not decrease infections in hospitals, having the staff well educated and informed and confident to discuss this with patients, relatives and visitors would reduce healthcare infections further.

 

The Department of Health had commissioned a survey of the general public, and marrying these two together could be an advantageous.  Having the public well educated regarding healthcare infections would prepare them before going into hospital.  There was concern from some quarters that whilst it's encouraging to raise awareness, it may raise a fear factor.  The counter argument to this, is that whilst the press and media may at first jump on the band-wagon, this can easily be countered by saying that education, information and communication makes people better prepared for what may be facing them, and that reducing healthcare infections is in the words of a microbiologist is an "all or nothing affair".

 

It was agreed by all that having an information, communication and education campaign is key to educating everyone concerned, and the discussions will follow on how best to develop the campaign.