Patient awareness of healthcare-associated infection risk and prevention: Has there been a change in 3 decades (1989-2019)?

Using a 1989 baseline study, we surveyed 1,004 US consumers in 2019 on education and awareness of healthcare-associated infection (HAI) risk and prevention. Awareness of HAI risk remains unchanged (62% vs 65%) but belief HAIs are preventable dropped (83% vs 28%). Medical professionals and the internet are top information sources.

Irritant Contact Dermatitis on Hands.

Hand hygiene (HH) is the single most important procedure health care workers (HCWs) can follow to reduce the risk of spreading health care-associated infections, yet compliance with this simple task remains at less than 50%. One of the reasons often cited for noncompliance is irritant contact dermatitis (ICD) resulting from repeated exposure to HH products and procedure. This literature review used the World Health Organization's components of empowerment as a guideline for the search and development of a clinical model to address HCW HH and ICD.

A Review of Electronic Hand Hygiene Monitoring: Considerations for Hospital Management in Data Collection, Healthcare Worker Supervision, and Patient Perception.

Healthcare-associated infections (HAIs) in U.S. acute care hospitals lead to a burden of $96-$147 billion annually on the U.S. health system and affect 1 in 20 hospital patients (Marchetti & Rossiter, 2013). Hospital managers are charged with reducing and eliminating HAIs to cut costs and improve patient outcomes. Healthcare worker (HCW) hand hygiene (HH) practice is the most effective means of preventing the spread of HAIs, but compliance is at or below 50% (McGuckin, Waterman, & Govednik, 2009). For managers to increase the frequency of HCW HH occurrences and improve the quality of HH performance, companies have introduced electronic technologies to assist managers in training, supervising, and gathering data in the patient care setting. Although these technologies offer valuable feedback regarding compliance, little is known in terms of capabilities in the clinical setting. Less is known about HCW or patient attitudes if the system allows feedback to be shared. Early-adopting managers have begun to examine their experiences with HH technologies and publish their findings. We review peer-reviewed research on infection prevention that focused on the capabilities of these electronic systems, as well as the related research on HCW and patient interactions with electronic HH systems. Research suggests that these systems are capable of collecting data, but the results are mixed regarding their impact on HH compliance, reducing HAIs, or both and their costs. Research also indicates that HCWs and patients may not regard the technology as positively as industry or healthcare managers may have intended. When considering the adoption of electronic HH monitoring systems, hospital administrators should proceed with caution.

Patient empowerment begins with knowledge: consumer perceptions and knowledge sources for hand hygiene compliance rates.

A survey of 1,000 US consumers quantified their knowledge of health care worker hand hygiene compliance, their information sources on hand hygiene rates, and their past behavior of asking health care workers to perform hand hygiene. Sixty-nine percent of respondents believed compliance is above 50%; 17% of respondents had asked a health care worker to perform hand hygiene. Our findings suggest that an organized plan of disclosure about hand hygiene rates may be a way to empower through knowledge.

Public reporting of healthcare-associated infections: epidemiologists' perspectives.

Public reporting of healthcare-associated infections is pervasive, with 33 states and the District of Columbia mandating public disclosure. We surveyed hospital epidemiologists on the perceived value of state public reports. Respondents believed consumers are unaware and do not consider the information important, but they indicated that epidemiologists have a role in consumer education.

Patient empowerment and multimodal hand hygiene promotion: a win-win strategy.

Patient empowerment is a new concept in health care that has now been extended to the domain of patient safety. Within the framework of the development of the new World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care, the authors conducted a review of the literature from 1997 to 2008 to identify the evidence supporting programs aimed at encouraging patients to take an active role in their care. Patient empowerment is an integral part of the WHO hand hygiene multimodal strategy. Hand hygiene promotion strategies that have demonstrated evidence of successfully empowering patients include one or all of the following components: educational tools, motivation and reminder tools, and role modeling. What is important is that programs and models to empower patients must be developed with an inbuilt evaluation component that includes both qualitative and quantitative measures to determine not only what works but under what conditions and within which organizational context.

Hand hygiene compliance rates in the United States--a one-year multicenter collaboration using product/volume usage measurement and feedback.

Hand hygiene (HH) is the single most important factor in the prevention of health care-acquired infections. The 3 most frequently reported methods of measuring HH compliance are: (1) direct observation, (2) self-reporting by health care workers (HCWs), and (3) indirect calculation based on HH product usage. This article presents the results of a 12-month multicenter collaboration assessing HH compliance rates at US health care facilities by measuring product usage and providing feedback about HH compliance. Our results show that HH compliance at baseline was 26% for intensive care units (ICUs) and 36% for non-ICUs. After 12 months of measuring product usage and providing feedback, compliance increased to 37% for ICUs and 51% for non-ICUs. (ICU, P = .0119; non-ICU, P < .001). HH compliance in the United States can increase when monitoring is combined with feedback. However, HH still occurs at or below 50% compli- ance for both ICUs and non-ICUs.

Interventional patient hygiene model: Infection control and nursing share responsibility for patient safety.

Interventional patient hygiene (IPH) has been defined as a comprehensive evidence-based intervention and measurement model for reducing the bioburden of both the patient and health care worker. The components of IPH are hand hygiene, oral care, skin care/antisepsis, and catheter site care. This practice form will provide evidence-based information for each of the components of IPH model and provide a strategy for the development, implementation, and monitoring of IPH protocols.

The effect of random voice hand hygiene messages delivered by medical, nursing, and infection control staff on hand hygiene compliance in intensive care.

Hand hygiene (HH) compliance in the intensive care unit has been studied extensively, with short-term, nonsustained compliance often because of lack of ongoing reinforcement. HH messages delivered by health care workers responsible for overseeing staff in the intensive care unit provided continuous reinforcement of HH. Compliance measured through product usage and reported as HH/bed-days increased by 60% for soap and sanitizer combined and 25% for sanitizer usage (P < 001).

Consumer attitudes about health care-acquired infections and hand hygiene.

Mandatory reporting and disclosure of health care-acquired infections have resulted in controversy over the perceived notion that consumers will not understand how to interpret data and that such information may negatively influence utilization of hospitals. The objective was to determine consumers' attitudes about health care-acquired infections, hand hygiene practices, and patient empowerment. A telephone survey based on a random digit dialing sample of all households in the United States was conducted. Consumers were asked about choosing a hospital, hand hygiene practices, and health care-acquired infections. Some 94% of respondents rated environmental cleanliness as very important. Hospital infection rates would influence decision making for 93% of consumers. Four in 5 consumers said they would ask their health care worker to wash and sanitize his or her hands. Our findings strongly suggest that (1) consumers will use infection data in selecting and/or leaving a hospital system and (2) consumers are ready to be empowered with information to ensure a positive outcome.

A descriptive review of malpractice claims for health care-acquired infections in Philadelphia.

BACKGROUND: Philadelphia's rate of malpractice filings per population is just over double the national median. Plaintiffs prevail in 44% of verdicts in Philadelphia compared with 20% for all US jury verdicts, with 24% of awarded verdicts in excess of $1 million. OBJECTIVE: To determine patient and procedure demographic data for malpractice claims involving health care-acquired infections (HAIs) in Philadelphia. METHODS: Risk managers representing 60 acute care hospitals, members of Pennsylvania Trial Lawyers Association, and a random sample of 560 lawyers representing plaintiff and defense cases obtained from the Philadelphia Court of Common Pleas database (1996-2002) were surveyed. The survey included the following: number of HAI cases by specialty, body site, isolate, and outcome. RESULTS: Overall response rate was 25% (n = 154 cases). The highest numbers of cases were in the specialties of orthopedics (69), general surgery (20), and cardiothoracic (20). Sites infected most often were as follows: knees (26), back (26), sternum (18), and harvest site (10). Methicillin-resistant Staphylococcus aureus (MRSA) was responsible for 45 of cases, S epidermidis for 27, methicillin-susceptible S aureus (MSSA) for 14, and Pseudomonas for 16. Twenty-seven of the cases were withdrawn, 27 settled, 11 pending, 9 plaintiff verdict, and 5 defense verdict. CONCLUSIONS: Although 72% of HAI malpractice cases in Philadelphia were either withdrawn or settled, when brought to trial, the plaintiff was more likely to succeed with a verdict. Our findings also suggest that the most frequent type of infection (class I-surgical site) and isolate (MRSA) are more likely to be seen as preventable HAIs because of National Nosocomial Infection Surveillance data showing lower infection rates for this class of surgery and therefore seen as easier for the plaintiff to show that the defendant failed to adhere to the standard of care for infection control.