The Patient's Perception of Hand Hygiene Practices of Their Healthcare Providers

Background:   The significance of hand hygiene (HH) has been well documented for over a century, yet compliance often remains low.  Compliance has been monitored by many methods including encouraging patients to speak up and ask their healthcare providers (HCP) to clean their hands.  This study examines the patient's perception concerning their HCPs compliance with HH practices and their comfort in asking HCPs to clean their hands.

Objective: To learn more about the patient's perception of HH practices, their comfort in requesting their HCP to perform HH and to provide unit specific feedback reflecting patient's input about HH compliance. 

Methods:   The study was conducted by interviewing patients on 4 units of a tertiary acute care hospital using a dialogue script and questionnaire with questions about their observations of HCP practices, their understanding about HH and their comfort in addressing HH issues with their HCP.  The study took place during March 4-24, 2009, and was conducted by one interviewer who met with 160 English speaking patients or respective family member. Data were recorded in standardized questionnaires and analyzed using Epi Info Version 3.5.1 statistical software.

Results: Of 160 persons who were approached, 154 (96.3%) agreed to participate. Of these 154 interviews, 130 were directly with patients; the other 24 were with family members.  Participants were interviewed on the Neurosurgery (n = 39), Labor & Delivery (n = 38), Liver Transplantation (n = 40), and Trauma (n = 37) units of a 1983-bed hospital.  The study population represented both genders; mean age: 33 (range: 16 – 86) yr.  Neurosurgery participants were more likely to indicate that a HCP had counseled them on HH, likely reflecting the unit’s overall infection prevention initiative.  Overall, patients who observed hand cleansing among staff, and patients who felt comfortable asking staff to clean hands were aged <55 yr (p <0.05); mostly female; Caucasian; knew about alcohol hand rubs.

Conclusions:   The interview format elicited a high response rate and enabled unit-specific feedback with compliments for staff and opportunity to improve HH practices.  Also, these results suggest a strong need for more HH education and the involvement of all parties (HCP, patient, and visitors) in improving compliance.  Population-specific education may be needed to make patients aged >55 yrs or of different ethnic groups feel more comfortable in alerting their HCP to maintain HH; but had not discussed HH with hospital staff.  No other association between age, gender, race, HH discussions with staff, or patient knowledge of the role of alcohol in HH and the outcome variables were found.