Allow me to set the scene: I was visiting an elderly relative in an NHS hospital recently (they would deny being elderly – but I’m afraid it is now true). I witnessed a healthcare worker moving efficiently from bed to bed examining each patient (including direct patient contact) to take observations without any hand hygiene between patients and without decontamination of the reusable blood-pressure cuff. I explained to my relative the need to challenge this behaviour. My relative asked – almost pleaded with me – not to intervene saying “you’ll clear off and they’ll be left caring for me overnight”. So, did I have the courage to defy my relative and challenge this behaviour?
I’ll tell you later. But before I do, let me turn your attention to a recent study in AJIC. A survey of healthcare workers, patients, and relatives examined attitudes towards patients challenging healthcare workers about poor hand hygiene practice. Of the 196 healthcare workers surveyed, only 32% supported patients challenging hand hygiene practice (42% of doctors and 25% of nurses). The main reasons that doctors took this view was a perceived lack of patient expertise to make a useful challenge (aka “patients don’t know what they’re on about”), and concerns about how it would damage the patient-doctor relationship (aka “this would erode my sense of power”). Depressingly, the main reason for nurses not supporting patient participation what that it is unnecessary (aka “inconvenient”).
From a patient viewpoint, among the 337 patients and relatives surveyed, the main reason for not challenging healthcare workers about hand hygiene was a fear of either causing annoyance of being treated differently (76%) – the same concern held by my relative. The authors found that being female, younger than 55, having a higher level of education, and observing hand hygiene practice were significantly associated with an intention to challenge staff about hand hygiene.
My own view is that we should embrace patients and their relatives as a useful source of ‘nudge’ reminders about hand hygiene. Healthcare workers came into this business to do the right thing, not to harm patients, and most will respond well to being challenged about hand hygiene practice. But perhaps we need a less combative language for the dialogue (“ask me about hand hygiene” vs. “challenge poor practice when you see it”), and perhaps we need to give patients and visitors express permission to remind staff about hand hygiene. It’s not right to make patients accountable for ensuring that staff perform hand hygiene when caring for them: that responsibility rests with the healthcare worker. But the more nudge reminders we can introduce into the clinical setting, the better.
So…did I challenge the healthcare worker who was going from bed to bed without performing hand hygiene? In the end, I did not. But I wish that I had. In hindsight, I should have found a way to gently remind the healthcare worker about hand hygiene without creating tension. I guess that I didn’t think quickly enough. Fortunately, my mum was discharged without any signs of infection. But others are not so lucky. So, let’s all find ways to productively include our patients and their relatives in our efforts to get hand hygiene right.