Nearly 97 percent of health professionals wash their hands when patients are asked to watch

Improving hand hygiene compliance by healthcare professionals is no easy task, but a first-of-its-kind Canadian study by researchers at Women's College Hospital shows simply asking patients to audit their healthcare professional is yielding high marks.

The study, published in the April edition of the American Journal of Infection Control, details the findings of an 11-month pilot project looking at an alternative method of auditing using the patient-as-observer approach. In this method, patients observe and record hand of their via a survey distributed before their interaction with their healthcare provider. It is believed Women's College Hospital is the first Canadian outpatient hospital using this method.

"Involving patients as the monitors of their healthcare providers' hand hygiene seems like an obvious, simple choice, and yet, most hospitals in Canada don't use this method; many opt for the often costly and time consuming alternatives such as having their colleagues monitor and audit," said Jessica Ng, one of the leading authors of the study and manager of infection prevention and control at Women's College Hospital.

In the pilot project, patients were asked to voluntarily observe the hand hygiene practices of their healthcare providers during their visit and record their findings anonymously on a survey card given to them by a hospital volunteer. They cards were returned back to the volunteer on their way out. Physicians, residents and staff were aware of the pilot through staff meetings, fact sheet distribution, and monthly progress meetings and reports.

"We not only gathered the healthcare provider hand hygiene compliance data through patient observers, but also encouraged and empowered patients to be more engaged in their care by directly involving them in auditing," said Ng.

The pilot project, conducted between August 2012 and June 2013 at Women's College Hospital's Family Practice Health Centre, one of Ontario's largest clinics with an estimated 54,000 patient visits annually, was adapted and customized from a method used at Johns Hopkins Hospital. The authors found that:

• Based on patient observations, the overall hand hygiene compliance rate by healthcare providers before direct contact with their patients was 96.8 per cent

  • As part of the evaluation, the patient-as-observer approach was validated by trained nurses. Patient and nurse hand hygiene auditing data matched 86.7 per cent of the time, suggesting that patients were generally able to accurately observe health care providers' hand hygiene practices
  • Patients engagement was high, resulting in more than 75.1 per cent survey card return rate

A survey of the healthcare providers conducted after the pilot indicated that:

  • 58 per cent of providers experienced a change in their hand hygiene practices and 88 per cent reported being more motivated to perform hand hygiene knowing their patients were observing
  • 33 of providers reported increased conversations with patients about infection protection and control, increasing patient education and patient engagement in their own healthcare

The authors felt that the was so successful that it is now being implemented in other areas of the hospital.

"The patient-as-observer approach is a practical, accurate and cost-saving alternative to the time and resource-intensive direct observations by a paid hospital employee," said Dr. Michael Gardam, director of infection prevention and control at Women's College Hospital and senior author of the study. "It's a promising tool for championing patient safety and quality improvement, because it supports education, engagement and empowerment of to play a more active role in their own healthcare," said Gardam.

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