Skip to main content

Patient Safety a Catalyst for Tighter Infection Controls

 |  By John Commins  
   September 07, 2011

A study showing that hand washing increases among medical professionals when the organizational emphasis is on patient safety is hardly breaking news, but it should be a key motivator for other infection control practices, one infection control advocate says.

Russ Olmsted, president of Association for Professionals in Infection Control and Epidemiology, Inc., said in an email to HealthLeaders Media he was "encouraged" to see social scientists "share an interest in the behavioral aspects of patient care" and Olmsted said he welcomed additional research.

The study Olmsted cited,It's Not All About Me: Motivating Hospital Hand Hygiene by Focusing on Patients,found significantly better compliance with hand hygiene when hospital signage encouraged healthcare professionals to consider the health and safety of their patients, rather than themselves. The study will appear in Psychological Science.

"Clearly we have a healthy supply of products to support hand hygiene. The 'missing ingredient' however is perhaps a better understanding of human behavior in the healthcare environment and then the application of interventions that use findings such as this from social sciences," Olmsted said.

"The knowledge from social sciences can also be applied to other interventions aimed at preventing cross infection, such as use the of personal protective equipment when caring for patients on isolation precautions, implementation of infection prevention "bundles" for devices needed for patient care, e.g. central venous catheters, and even hygiene for the inanimate environment," he said.

The study posted one of three signs – each with a different emphasis -- at 66 hand-washing stations at several hospitals. The signs read: "Hand hygiene prevents you from catching diseases;" or "Hand hygiene prevents patients from catching diseases," or "Gel in, wash out." The study measured soap dispenser volumes over two weeks and found that staff used 33% more soap when the signage emphasized patient safety.

While he was encouraged by the study' findings, Olmsted says that emphasizing patient safety first in infection control is not a new idea. It has long been the centerpiece of hand hygiene initiatives adopted by the World Health Organization , the U.S. Centers for Disease Control and Prevention, and by APIC itself. 

"Overall therefore while the findings of this study are useful it's important (to) understand there is a fairly high level of penetration of the message that hand hygiene = patient safety across providers in North America and beyond," Olmsted says.

Despite those recommendations from WHO, CDC, APIC and other organizations, study co-author David A. Hofmann said there is no definitive answer for why significant numbers of healthcare professionals continue to neglect hand hygiene.

"That is the $64 million dollar question," says Hofmann, a professor of organizational behavior Kenan-Flagler Business School, University of North Carolina at Chapel Hill.

 "Physicians are potentially overconfident in their own immune systems and the lack of a one-to-one causal between hand washing and them getting sick creates a situation where they don't perceive the risk as that high," he says. "When we shift the sign message to the patient it highlights a very vulnerable person in the context that could be affected by this behavior and it may also trigger going back to the Hippocratic Oath which is 'First do no harm.'"

And while there was an immediate short-term uptick in hand-hygiene that could be related to the signage, Hofmann says it's not clear if the message might become muted over time. "We did a two-week study and found an effect but it does beg the question of 'over time do the signs fade into the environment and no longer impact behavior?'" he says.

Olmsted says he'd like to see a study measuring the longer-term effects of patient-centered signage for hand hygiene. "An investigation of longer duration and perhaps involving a wider range of healthcare facilities would be helpful to verify that their findings can be sustained," he says.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Tagged Under:


Get the latest on healthcare leadership in your inbox.