Empowering patients in the hospital as a new approach to reducing the burden of health care–associated infections: The attitudes of hospital health care workers

doi:10.1016/j.ajic.2015.10.003

American Journal of Infection Control

Volume 44, Issue 3, 1 March 2016, Pages 263-268

https://doi.org/10.1016/j.ajic.2015.10.003 Get rights and content

Background

Any approach promoting a culture of safety and the prevention of health care–associated infections (HCAIs) should involve all stakeholders, including by definition the patients themselves. This qualitative study explored the knowledge and attitudes of health care workers toward the concept of patient empowerment focused on improving infection control practices.

Methods

Semi-structured interviews were undertaken with 29 staff from a large hospital in Sydney, Australia.

Results

There was virtually unanimous agreement among the participants that patients should be thought of as a stakeholder and should have a role in the prevention of HCAI. However, the degree of patient responsibility and level of system engagement varied. Although very few had previously been exposed to the concept of empowerment, they were accepting of the idea and were surprised that hospitals had not yet adopted the concept. However, they felt that a lack of support, busy workloads, and negative attitudes would be key barriers to the implementation of any empowerment programs.

Conclusion

Although the World Health Organization has recommended that patients have a role in encouraging hand hygiene as a means of preventing infection, patient engagement remains an underused method. By extending the concept of patient empowerment to a range of infection prevention opportunities, the positive impact of this intervention will not only extend to the patient but to the system itself.

Section snippets

Study design

A qualitative methodology was used for 3 reasons. First, qualitative research methods are used extensively where the research topic is exploratory, as in the case of this study.¹⁶ Second, such methods are considered both appropriate and valuable in the study of quality improvement processes in health care.¹⁷ Finally, the same methods (semi-structured interviews) has been used in published research on HCAIs.18, 19 An iterative 2-round process of in-depth interviews was undertaken with hospital

Results

A total of 29 interviews were undertaken with hospital staff members (12 in the first round and 17 in the second round). Of the participants, 18 were women, 12 were aged ≤34 years, and 20 were registered nurses. Participants covered a broad range of experiences working in health care, ranging from 1-39 years (median, 14 years). Most participants had been working in their current role for a median period of 4.6 years (minimum, 3 weeks; maximum, 32 years).

The interview results are subsequently

Discussion

This study explored the opinions of HCWs toward the concept of patient empowerment and the role of the patient in promoting HH and preventing HCAI. Among the participants of this study, there was a strong tendency to relate the concept of empowerment, which was understood to be the process for improving patient safety, primarily to encourage patients to improve their own behaviors, such as improving their or their family's compliance with personal hygiene or HH, and to the provision of

Conclusion

Most health organizations have recognized the potential of patient empowerment as a way of improving the HH behaviors of HCWs. Before facilities consider introducing a program such as this, they need to consider the following: (1) whether they have the infrastructure to support the program; (2) the mechanism they are going to use to educate and promote engagement and communication; (3) how they are going to align the culture at the facility toward the approach; and (4) how to evaluate the

Acknowledgments

We thank all the participants who gave their time to take part in the interviews. We also thank Professor Raina MacIntyre, Professor Phillip Crowe, and Professor Julian Gold for their input into the design.

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Supporting patients and their carers to participate in infection prevention and control activities: The views of patients, family members, and hospital staff from Bangladesh, Indonesia, and South Korea
2024, American Journal of Infection Control
Hand hygiene reminders for healthcare workers (HCWs) are commonly used to empower patients. However, this approach overlooks the role of family carers in delivering direct contact care in Asian countries. Limited knowledge exists regarding empowerment strategies for patients and their family carers in infection prevention and control (IPC) recommendations. This study aimed to provide a comprehensive exploration of IPC empowerment within the context of family involvement in care provision across Bangladesh, Indonesia, and South Korea.
In-depth interviews were conducted in 5 tertiary-level hospitals in Bangladesh, Indonesia, and South Korea. A total of 64 participants were interviewed through 57 interviews, including 6 group interviews, comprising 2 groups: (1) patients and their family and private carers; and (2) HCWs.
The study identified barriers to engaging patients and family carers in IPC measures. These included concerns about the patient-HCW hierarchical relationship, lack of knowledge about healthcare-associated infection, IPC, and patient zone, perceptions of IPC as a barrier to family connections, and disempowerment of patients in IPC due to family bonds.
This study provides diverse perspectives on IPC empowerment, revealing challenges faced by patients, family carers, and HCWs. The interlaced relationship established by social norms of family carer provision hinders the empowerment of family carers. Acknowledging the cultural influence on health care arrangements and its implication for IPC empowerment is crucial in mitigating these barriers.
Hospital patient experiences of contact isolation for antimicrobial resistant organisms in relation to health care–associated infections: A systematic review and narrative synthesis of the evidence
2023, American Journal of Infection Control
The alarming growth of antimicrobial resistance organisms (AMRs) and the threat caused by health care–associated infections require hospitalized individuals who are infected or colonized with AMRs to be cared for in isolation, predominantly in single rooms. None of the existing reviews focus on or specifically address the patient’s experience of being cared for in contact isolation when affected by AMRs exploring this specific context.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance for the conduct of systematic reviews was applied. Five databases were searched from inception to April 2019, with keywords related to adult patient experiences, AMR, and contact isolation. The evidence was certified by 2 reviewers. Principles of thematic analysis were used to produce a narrative synthesis of the findings.
Eighteen eligible studies were identified. Narrative synthesis resulted in 3 overarching categories reflecting the patient experience: privacy versus loneliness; emotional responses to isolation; quality of care, recovery, and safety in isolation.
This review synthesizes existing evidence reflecting the patient experience of contact isolation. Study findings were often contradictory and may not reflect contemporary health care, such as shorter hospital stays, or societal preferences for greater privacy. Further research focusing on contemporary health care contexts is recommended.
Lifting the curtains of silence: Patient perceptions towards needs and responsibilities in contributing to the prevention of healthcare-associated infections and antimicrobial resistance
2023, American Journal of Infection Control
Citation Excerpt :
Others suggested mobile phone applications would be another way to deliver patient information. The suggestion of patient participation to reduce the risk of HAIs in the health care setting is not new, and previous studies have examined the facilitators and barriers impacting engagement.9,13-17 However, to date, there has been a systematic failure to identify the mechanisms to support patients moving from being ‘willing’ participants to actively engaging in the activities.
Beyond the use of policy and system-focused approaches, it has been established globally that patients can play a role in enhancing the health care landscape. However, efforts to meaningfully translate patient engagement strategies that promote participation by hospitalized patients in relevant infection prevention and antimicrobial stewardship activities have not yet been realized. This study mapped the key factors acting as barriers and facilitators of patient engagement using a theoretical framework to identify potential new approaches to promote engagement.
Semistructured interviews were conducted with 36 patients from 3 major hospitals in Sydney, Australia, in 2019. Transcripts were inductively analyzed, with the resulting themes categorized into the components of the Capability-Opportunity-Motivation-Behavior model.
The themes regarding barriers to patient engagement with relevant infection prevention and antimicrobial stewardship activities were: (1) Capability: misunderstanding and knowledge gaps about antimicrobial resistance; (2) Opportunity: strong family/patient support networks and good relationships with nursing staff provide an opportunity to support engagement; (3) Motivation: those who have some level of understanding or experience see the benefit and are most likely to engage actively.
Assuming patients are inclined to participate in efforts, a logical starting point would be to build awareness amongst patients and providers; however, education will not suffice. There needs to be a system and policy shift to ensure that patient engagement is recognized as a worthy endeavor.
Central Line Care and Management: Adopting Evidence-Based Nursing Interventions
2021, Journal of Perianesthesia Nursing
Citation Excerpt :
Leaflet or quick reference tools created by professional organizations, such as the World Health Organization, can be used to provide patients and families hands on tool to support the need for hand hygiene. Engaging patients and families with expected care interventions has been shown to improve health care provider compliance with best practices.14,15 Changing central line dressings is a skill all perianesthesia nurses must know and perform using the best practice techniques available.
Central line–associated bloodstream infections occur not only in the intensive care unit but also the non–intensive care units of the hospital. The purpose of this article is to review current evidence to guide perianesthesia nurses in the care of a patient with a central vascular access device (CVAD). The CVAD bundle focuses on five key elements: hand hygiene, maximal sterile barrier, chlorhexidine antiseptic, catheter site selection, and daily evaluation of the need for the device. Once the CVAD is placed, evidence-based care and maintenance are the responsibility of the nurse. Ensuring proper maintenance and care of a CVAD falls within nursing practice and interventions can significantly reduce the patient's risk of central line–associated bloodstream infection. The single most crucial step a nurse can take to help prevent central line–associated bloodstream infections is performing proper hand hygiene. Other interventions focus on dressing management, bathing practices, access of intravenous infusion sets, blood draws, and management of port line occlusions. Familiarity and adoption of best practice interventions in the maintenance and care of patients with CVADs will help the perianesthesia nurse protect patients and prevent harm.
When the nutritionnal screening is entrusted to the patient: A prospective observational study in a belgian university hospital
2020, Nutrition Clinique et Metabolisme
La dénutrition est un problème majeur dans la prise en charge du patient. Le dépistage nutritionnel, prérequis essentiel, est souvent insuffisamment réalisé pour diverses raisons : manque de temps, de ressources humaines… Une étude prospective observationnelle monocentrique a été menée durant neuf semaines afin de valider l’hypothèse qu’il était possible de faire participer le patient en lui demandant de fournir seul les informations nécessaires à l’établissement d’un diagnostic nutritionnel dans les 48 heures de son admission.
Le patient complétait à l’admission un document reprenant les données nutritionnelles nécessaires à l’établissement du diagnostic nutritionnel. Ensuite, le même questionnaire était réalisé par le diététicien de l’équipe investigatrice qui établissait le diagnostic nutritionnel à la fois sur base des éléments transmis par le patient (diagnostic patient) et sur base de ses données (diagnostic diététicien). La corrélation entre ces deux diagnostics a été analysée par le kappa de Cohen et le kappa quadratique.
Le document fut complété par 281 patients ; 167 furent confrontés à celui réalisé par le diététicien. Sur base des questionnaires patients, un diagnostic fut possible pour 158 des 167 questionnaires. Le kappa de Cohen et le kappa quadratique étaient respectivement de 0,74 et 0,84. En ce qui concerne le délai du dépistage, 162 de ces 167 patients ont remis leur questionnaire dans les 48 heures de l’admission.
Ce travail valide l’hypothèse de faire du patient l’acteur principal d’un dépistage nutritionnel de qualité et disponible dans les 48 heures de l’admission.
Undernutrition is a major problem when you have to take in charge a patient. Nutritional screening, essential prerequisite, is insufficiently done for various reasons: lack of time, lack of human resources… A prospective observational monocentric study has been conducted during nine weeks to validate the hypothesis that it was possible to empower the patient by asking him/her to provide the information needed to establish a nutritional diagnosis within 48 hours of admission.
On admission, the patient completed a document containing the nutritional data needed to establish the nutritional diagnosis. Then, the same survey was conducted by the dietician of the investigative team who made the nutritional diagnosis based on both the elements shared by the patient (patient's diagnosis) and the ones of his own data (dietician's diagnosis). The correlation between these two diagnosis has been analyzed by Cohen's kappa and the quadratic kappa.
281 patients filled in the document; 167 documents were compared to the one made by the dietician. Based on the patients’ forms, a diagnosis was possible for 158 out of 167 questionnaires. The Cohen's kappa and quadratic kappa were respectively of 0,74 and 0,84. As far as the timing of the screening is concerned, 162 of these 167 patients submitted their questionnaires within 48 hours of the admission.
This study validates the hypothesis of making the patient the main actor of a qualitative nutritional screening and available within 48 hours of admission.
Discourse on hygiene between hospitalized patients and health care workers as an accepted norm: Making it legitimate to remind health care workers about hand hygiene
2020, American Journal of Infection Control
Citation Excerpt :
Today, the importance of education and instruction regarding hand hygiene (HH) and acquired infections is mentioned in World Health Organization (WHO) guidelines and by the US Centers for Disease Control and Prevention and is included in the intervention cluster developed by Pincock et al.6 Nevertheless, none of these reports provides the public with specific guidelines or behavior recommendations on this subject. Despite WHO recommendations that patients should play a role in encouraging HH as a means of preventing infection, patient engagement remains an underused approach.7 The literature deals mainly with intervention programs to improve compliance among health care workers (HCWs) in maintaining HH.
Despite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs.
Intervention type 2 design and examination of 2 population groups—HPs and HCWs—before and after intervention by means of mixed methods research.
Both HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation.
To overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.

View all citing articles on Scopus

: Funding/Support: Supported by the South Eastern Sydney Local Health District, Sydney, Australia.

: Conflicts of interest: None to report.

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Major articleEmpowering patients in the hospital as a new approach to reducing the burden of health care–associated infections: The attitudes of hospital health care workers

Background

Methods

Results

Conclusion

Section snippets

Study design

Results

Discussion

Conclusion

Acknowledgments

Mayo Clin Proc

Am J Infect Control

J Hosp Infect

Am J Infect Control

Am J Infect Control

J Hosp Infect

Patient Educ Couns

Soc Sci Med

Patient Educ Couns

Key concepts in consumer and community engagement: a scoping meta-review

BMC Health Serv Res

Self-management support for insulin therapy in type 2 diabetes

Diabetes Educ

Learning to empower patients. Results of professional education program for diabetes educators

Diabetes Care

An analysis of the concept of empowerment

J Adv Nurs

The road to empowerment: a historical perspective on the medicalization of disability

J Health Hum Serv Adm

Integrating patient empowerment as an essential characteristic of the discipline of general practice/family medicine

Eur J Gen Pract

WHO guidelines on hand hygiene in healthcare

Major article
Empowering patients in the hospital as a new approach to reducing the burden of health care–associated infections: The attitudes of hospital health care workers