Hospitalized Patients’ Hand Hygiene Perceived Level of Knowledge and Practice Said Abusalem, PhD, RN Timothy Crawford, PhD, MPH Angie Malone, MSN, APRN, ACNS-BC, OCN Kristin Mefford, BSN, OCN Paul Alper, BA Claire Stage, BSN Student Amanda Speller. BSN Student Barbara Polivka, PhD, RN

Acknowledgement This study was supported by: Norton Women's and Kosair Children Hospital DebMed Healthcare Iota Zeta Chapter grant, Sigma Theta Tau International Shirley L. Powers grant Authors declare no conflict of interest.

Overview Hand Hygiene (HH) is the most effective means of preventing Healthcare Associated Infections (HAI). HH is endorsed as a standard practice for health care settings by the CDC, the World Health Organization (WHO), and the Joint Commission (JC). HAI occur annually at a rate of 1.4 million cases globally; 20% to 40% of all cases are preventable.

Overview Focus of HH has traditionally been on health care workers which has contributed to an absence of the patient’s role in HH. Given that the patient is the center of the care process, effective patient- centered involvement is needed. Patient HH is the single most cost effective intervention for the prevention of HAI. In this time of financial difficulty and mounting costs of health care and HAI, Patient-Centered Hand Hygiene (PCHH) is critical.

Overview The PCHH initiative is “the next step in infection prevention and control” (Lander et al., 2012). Decreasing and preventing HAI reduces length of hospital stay, pain, medical procedures, lost productivity, and associated health care costs. Hospitals, under the value-based purchasing initiative, will not be reimbursed for HAIs A successful PCHH interventions can reduce hospital costs.

Study Aims To assess patients’ perceived knowledge and practice of hand hygiene during their stay in the hospital. To provide foundational work for development and testing of a PCHH Program.

Conceptual Framework The influencer model was used as a framework for this study (Grenny, Patterson, Maxfield, McMillan, & Switzler, 2013). The model organizes influence strategies into six sources that both motivate and enable patients to perform hand hygiene through personal, social, and structural arrangements. The availability of the Alcohol-Based Hand Rubs (ABHR) foam in the patient’s point of care is a change in the environment that serves as a structural ability influencer. Teaching HH will influence personal motivation, while reminders such as discussion, video, and handouts will influence the social motivation domain.

Diagram 1 The Influencer Model for Patient Hand Hygiene.

Method Cross-sectional survey conducted with 68 inpatients on a medical- surgical/ oncology unit. Inclusion criteria: English speaking; admitted to an oncology unit; alert and oriented to time, place, and person. Exclusion criteria: unable to perform HH due to a medical or surgical condition; disoriented or have a diagnosis of dementia. In addition, the charge nurse asked not to include terminally ill patients. Of the 68 participants, 22 (32%) were females and 46 (68%) were males.

Method -Continued A researcher developed patient-centered hand hygiene survey (31 items) based on the 9 Moments of Hand Hygiene proposed by Lander et al. 2012. Assesses patients’ attitudes and practices (20 items) and overall perceived self-competence in PCHH (13 items); An overall question rates participants’ ability to clean their hands the way they wanted from 0 to 10 (0 =never; 10 = always”) A question to assess if visitors used the alcohol hand rub bottle on the overbed table.

Procedure The unit charge nurse assessed admitted patients’ eligibility and notified the data collectors of potential subjects. Potential participants were approached about the study. The data collector explained the nature of the study. Patients who agreed to participate gave written informed consent. Data analysis included frequencies, summed scores, means, and standard deviations using SPSS software.

Findings (N=68) 36 % of participants rated themselves as practicing hand hygiene “most of the time” Participant responses to “I rub my hands with alcohol sanitizer before I eat” Always - 20% Most of the time -16% Sometimes - 31% Half of the time - 10% Never - 23%

Findings – Continued (N=68) Participants rated “When washing my hands, I usually spend more than 15 seconds” Always - 21% Most of the time - 11% Half of the time - 6% Sometimes - 47% Never - 15% Sixty patients (95%) reported having access to all hand cleaning supplies they needed

Findings (N=68) 36 % of participants rated themselves as practicing hand hygiene “most of the time” Participant responses to “I rub my hands with alcohol sanitizer before I eat” Always - 20% Most of the time -16% Sometimes - 31% Half of the time - 10% Never - 23%

Conclusion Findings strongly support the need to develop patient-centered hand hygiene interventions to foster patients’ hand hygiene performance during hospitalization.