Should patients remind hospital staff to perform proper hand hygiene?

Hospital Infections hits every tenth patient in the Western world and every fourth patient in the developing countries 1-4. The key to reducing hospital infections and reducing the development of multi-resistant bacteria is improved hand hygiene – particularly among hospital workers, as they represent the largest infection risk 5-8. Patients can potentially improve hospital staff hand hygiene compliance by reminding them to wash and disinfect the hands.

A systematic review from 2015 of Davis R. et al studied the effect of hygiene strategies to get patients to remember hospital staff to perform proper hand hygiene. The authors of the review identified 28 articles of relevance, 23 articles of which examined the effectiveness of patient-focused strategies (patients remember hospital staff to wash hands) and 5 articles, which examined the patients’ attitude to the hypothetical patient-focused strategies.

Hospital employees’ invitation turned out to be the best way to get patients involved in hospital staff hand hygiene. Video Campaigns and written material proved to be less effective.

Traditional hygiene campaigns with posters, flyers, stickers, etc. has been shown to have only a temporary effect on hand hygiene, because of ‘poster blindness”. Hand hygiene turned back to the starting point before hygiene campaign 10-13. Several studies have shown that hospital staff have better hand hygiene and culture, and that hand hygiene improves in cases when patients are involved and help medical workers to keep in mind to sanitize hands 14-22.

Something indicates that patients with good reason and good conscience can remind hospital staff to perform proper hand hygiene. In theory, it is simple to get patients to do this, but in practice, it turned to be difficult 23-25. Patients feel it inappropriate and anxiety provoking to remember hospital staff to perform proper hand hygiene. Patients are afraid to annoy, educate and undermine workers’ clinical skills, and they fear that this will destroy the patient-therapist relationship. Moreover, the patients feel, that it is their responsibility, and many patients assume that the hospital staff knows the importance of carrying out proper hand hygiene and probably they had already disinfected their hands 16, 26-28. In SaniNudge we believe that it is a big responsibility of patients. SaniNudge hygiene system is designed to take on this role. In an educational and anonymous way and using the latest research in behavioral psychology, the intelligent alcohol dispensers remind hospital employees to sanitize hands. This has been found to double the number of hands disinfected.