Monday, May 6, 2013

Patient Empowerment and Hand Hygiene

It has been a long two weeks on the internal medicine ward service. I am now free, for a bit at least, and back to blogging.

Achieving 100 percent hand hygiene compliance is an illusory dream. There is no single effective method for permanently improving hand hygiene. Strategies include surveillance and feedback, electronic prompts and monitoring, educational campaigns, strategic reminder posters and patient empowerment. An excellent review article on hand hygiene can be found here.

Here is an article summarizing patient empowerment and hand hygiene. The paper reviews the current literature on patient willingness to be empowered, barriers to empowerment, and hand hygiene programs that include patient empowerment and hand hygiene improvement. 

Several studies suggests that patients are willing to be empowered, however, there is variation in the actual number of patients that practice empowerment for hand hygiene, ranging from 5% to 80%. Patient empowerment can be enhanced when a patient is given explicit permission by a healthcare worker. 

To me it is not clear if patient empowerment can be sustained for meaningful impact on hand hygiene.  This is because of an asymmetry of power between doctor and patient. As a result, patients still balk at asking their doctors to wash their hands. I have explored hand hygiene from the patient's perspective before.

I am still unsure of how to effectively and consistently employ patient empowerment in a multi-modal hand hygiene program. 

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