Patient - Wash Thy Own Hands!
There has been increasing attention over the past decade in engaging patients in patient safety. In infection control this trend has manifest through efforts to have patients monitor and encourage hand hygiene compliance among health care workers. In a related trend, there is also increased interest in patients washing their own hands in a framework called "patient-centered hand hygiene." My understanding of this approach is that having patients clean their own hands could potentially increase their engagement in infection control initiatives including encouraging health care workers to practice hand hygiene. This approach might also have the additional benefit in decreasing the organism burden on patients' hands and interrupting direct or indirect transmission of MDROs in healthcare settings.
It is with this background that Kundrapu and colleagues at CWRU and the Cleveland VA completed a randomized trial of soap and water versus alcohol hand rub in reducing C. difficile spore burden on patients' hands. Forty-four infected or colonized patients were included in the study. Hand cultures were positive in 32% of patients with CDI and 38% of colonized patients prior to hand hygiene. As you can see from the figure below, soap and water significantly reduce the proportion of positive cultures and mean CFUs, while alcohol hand rub did not. Interestingly, around 10% of patients still had C. difficile recovered after washing with soap and water. Seems like a trial is in order to determine the role of patient hands in transmission and whether cleaner patient hands reduces the incidence of CDI and other MDROs in hospital settings. One major limitation is that this intervention could not be implemented in settings where the need is the greatest, namely ICUs, since most patients would be too sick to wash their hands.
In a related topic, I have always thought of patients advocating for hand hygiene among HCP is a great idea. However, my husband's colleague (neither of them medical professionals) described his recent experience in a hospital. He received a card upon admission to the facility requesting him to ask HCP to do hand hygiene. This guy was terrified that HE was supposed to monitor for hand hygiene among his care providers. My husband expressed the same concern, saying that is the hospital's responsibility (not the patients) to ensure hand hygiene compliance and that I shouldn't be thinking on doing something similar at my hospitals. I thought this was an interesting perspective from non-medical people on how patient involvement could potentially be misinterpreted.
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