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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., (Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

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 (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.

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).

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.

Background: Transmission of microorganisms from the hands of health care workers is the main cause of health care-acquired infections. Recent studies on bacterial contamination of hands by medical care specialty found the highest bacterial contamination on the hands of health care workers from rehabilitation units. The objective of this study is to determine the effect of a patient education model on hand hygiene (HH) compliance in a rehabilitation unit., Methods: A 6-week pre- and post-intervention study with a 3-month follow-up using a patient education model was conducted in a 24-bed inpatient rehabilitation unit located in an acute care hospital. Thirty-five patients were enrolled in the intervention phase of the study after agreeing to ask all health care workers who had direct contact with them, "Did you wash/sanitize your hands?" Compliance with the program was measured through soap/sanitizer usage per resident-day before, during, and after the intervention., Results: Usage increased from 5 HH per resident-day during the preintervention to 9.7 HH per resident-day during the intervention (P <.001), 6.7 HH per resident-day postintervention (6 weeks) (P <.001), and 7.0 HH per resident-day at 3 months (P <.001)., Conclusions: Patient education increased HH compliance in an inpatient rehabilitation unit by 94% during the 6-week intervention, 34% during the 6 week post intervention, and 40% at 3-month follow-up. This program empowers patients with responsibility for their own care and provides ongoing HH education.

Handwashing is one of the most important factors in controlling the spread of micro-organisms and in preventing the development of infections. The objective of this study was to determine the effectiveness of a comprehensive handwashing program on absenteeism in elementary grades. Two hundred ninety students from 5 independent schools were enrolled in the study. Each test classroom had a control classroom, and only the test classroom received the intervention (education program and hand sanitizer). Absenteeism data were collected for 3 months. The number of absences was 50.6% lower in the test group (P <.001). The data strongly suggest that a hand hygiene program that combines education and use of a hand sanitizer in the classroom can lower absenteeism and be cost-effective.

Each year, about 5% of people admitted to U.S. hospitals (about 2 million people) acquire an infection there. These infections cause nearly 20,000 deaths each year, and cost an estimated $4.5 billion to treat. Handwashing is the single most effective measure for preventing hospital-acquired infections. Despite widespread knowledge of the importance of handwashing, health care workers wash their hands far less often than is indicated. This Issue Brief describes a novel strategy to improve handwashing among hospital personnel, by involving the people with the most to gain--the patients themselves.

Partners in Your Care, a patient education behavioral model for increasing handwashing compliance and empowering the patient with responsibility for their care was evaluated in an acute care hospital in Oxford, UK. A controlled prospective intervention study comparing medical and surgical patients was performed. Ninety-eight patients were eligible for the study. Thirty-nine patients (40%) agreed to participate in the programme Partners in Your Care by asking all healthcare workers who were going to have direct contact with them "Did you wash your hands?" Compliance with the programme was measured through soap/alcohol usage and handwashings per bed day before and after its introduction. Partners in Your Care increased handwashing on average 50%. Healthcare workers washed hands more often with surgical patients than with medical (P< 0.05). Alcohol gel was used on less than 1% of occasions. Sixty-two percent of patients in study felt at ease when asking healthcare workers "Did you wash your hands?" Seventy-eight percent received a positive response (washed hands). All patients asked nurses, but only 35% asked physicians. Partners in Your Care increased handwashing compliance in the UK. This programme empowers patients with responsibility for their care, provides infection control staff with a continuing means for providing handwashing education without additional staff and can save costs for a hospital., (Copyright 2001 The Hospital Infection Society.)

Background: A review of the literature on handwashing has documented the absence of research on the education of the patient as an intervention model for changing staff behavior regarding handwashing compliance. The primary objective of this project was to conduct a prospective control study of the effect of patient handwashing education on staff compliance with handwashing., Method: A prospective, controlled, 6-week intervention/control study was performed in 4 community hospitals in South Jersey. Each hospital served as its own control. Patients were educated within 24 hours of admission about the importance of asking their health care workers to wash their hands. Soap usage and handwashing was calculated by bed-days. Patient follow-up was conducted through telephone interviews 2 weeks after discharge., Results: The patient handwashing education model increased soap usage by health care workers an average of 34% (P =.021); this increase was consistent across hospitals regardless of the initial soap usage rates. Of the patients interviewed, 81% read the materials provided, 57% asked health care workers whether they had washed their hands, and 81% of this 57% said they received positive responses., Conclusions: For the first time, our findings document that education of patients regarding their role in monitoring handwashing compliance among health care workers can increase soap usage and handwashing and provide sustainable reinforcement of handwashing principles for health care workers.

Hand washing is the single most important function in preventing the spread of infection. However, compliance by healthcare workers still remains under 50%. Intensive observational and interventional programs have been shown to increase compliance, but the increase in compliance is short-term. Therefore, in April 1998, we conducted a random survey of 500 members of the Association for Practitioners in Infection Control and the Society for Healthcare Epidemiology of America to determine the didactic educational practices (in-service lectures) of practitioners with regard to hand washing. Response rate was 18% (n = 90). Eighty-eight percent (73) conducted new employee orientation, 64% (73) conducted yearly in-service, whereas monthly, quarterly, and semiannual in-service were 11% (9), 11% (9), and 14% (12), respectively. Thirty-nine percent (35) of our respondents rated their compliance to hand washing as > 50%; 31% (19), < 50%; and, 39% (33) did not know. Only 5% (4) of our respondents determined the outcome measures and cost-effectiveness of their present handwashing program. Our survey had identified the lack of ongoing education for the healthcare worker about handwashing compliance. Continuous reinforcement through monthly in-service is labor-intensive and costly. An alternative model using the patient as ongoing reinforcement may be a solution for increasing compliance.

The duration of handwashing was studied in two community hospitals (teaching and nonteaching). The duration in seconds of 180 handwashes by health care personnel and 52 handwashes by non-health care personnel were recorded. The mean duration for health care personnel was 8.62 +/- 0.29 SEM; the degree of patient contact did not influence the duration of handwashing. The duration of handwashing was two times longer in health care personnel vs. non-health care personnel (8.62 +/- 0.29 vs. 4.14 +/- 0.42; t = 7.7; p less than 0.001). Comparisons revealed no statistically significant difference in duration between personnel at teaching and nonteaching hospitals or among those in different occupations. The data indicate that the duration of handwashing among health care personnel is below the standard recommended by authorities in hospital infection control. This may be an important factor in the transmission and persistence of nosocomial infection in critical care units. The antimicrobial efficacy of handwashing agents should be reevaluated considering the actual duration of handwashing by health care personnel within the hospital environment or efforts should be made to increase the duration of handwashing.

The frequency of handwashing in two intensive care units (ICUs) was observed. Handwashing after direct contact with patients or their support equipment was recorded. The ratio of beds to sinks was 1:1 in the medical ICU and 4:1 in the surgical ICU. Surveillance of physicians, nurses, and other personnel demonstrated a greater frequency of handwashing by nurses (63%) compared with physicians (19%) and other personnel (25%). The nurses in the unit with one sink per bed had a significantly greater number of handwashes (76%) than those in the unit with fewer sinks (51%).