Written by Petra Welsh, Leader, Infection Prevention and Control Strategy and Performance

We're sharing how staff in Royal Columbian Hospital's Acute Care for Elders unit is overcoming patient hand hygiene struggles by empowering patients to clean their own hands.

Hand hygiene is the single most important way of controlling the spread of micro organisms that can cause infection. But why stop at health care workers? Evidence suggests that good hand hygiene among patients can lead to significant reductions in hospital-acquired infections.

Gilma Johnston is the Clinical Nurse Educator for the Acute Care for Elders unit at Royal Columbian Hospital. She shares with us how her team is overcoming patient hand hygiene struggles by empowering patients to clean their own hands.

The patient population in the Acute Care for Elders (ACE) unit and H1N unit adjacent to the Emergency Department at Royal Columbian (RCH) are generally more than 65 years of age. Our older adult patients are particularly vulnerable to infections. Even though everyone on the unit works hard to try and avoid transmission of infections, we continued to find ourselves as one of the top 15 units in Fraser Health having the highest rate of C. difficile per 10,000 patient days.

In 2013, the ACE unit formed a C-Diff Action team to develop strategies to reduce C. difficile spread on the ACE and H1N units. The team included our infection control practitioner, manager, patient care coordinators (PCC), educator, health care aids, unit clerks, and nursing staff. The team initiated a work plan with clear goals, one being patient hand hygiene. Our goal was to provide an opportunity for 100 per cent of our patients to wash their hands before they enter and exit their room, before they ate, and after they used the toilet, commode, or bedpan.

We did our own quality improvement project where we trialed different products for four weeks each: personal alcohol-based hand rub (ABHR), wash basins and cloths, individually wrapped hand wipes and wipes in a large canister. Although wipes in a large canister requires manpower, our unit preferred this method as it allows an opportunity for us to provide education to our patients on hand hygiene when we distribute the wipes. The added benefit of wipes are that they are more effective in combatting C. difficile than alcohol-based hand rub.

The importance of patient hand hygiene is discussed during orientation for all staff and students. We also wrote a script for our staff to use to help ensure patients received education on the importance of hand hygiene. The C. difficile rates on the ACE unit have decreased significantly over the years. C. difficile rates have decreased from 27.7 per 10,000 patient days (2012/13), 11.4 on average(2013/14). We only had three cases of hospital-acquired C-diff in 2016.

Patient education at the time of providing hand hygiene products is key in achieving better compliance. ACE unit staff noticed that patients had a tendency to save their wipes until their meal was completed. The patients wanted to clean their hands of the crumbs from their food. This is one of the reasons staff provide patients with some education on why patients need to clean their hands before their meal.

As health care providers, we need to take every opportunity to talk with our patients about washing their hands and its importance in keeping them healthy.

In honour of World Hand Hygiene Day on May 5, we are asking care providers to partner with their patients to discuss the importance of cleaning their hands while in the hospital, and provide them the opportunity and products to perform hand hygiene. Please share your stories and photos of what your unit does to promote patient hand cleaning with the Infection Prevention and Control team at your site. These will be collated and shared through the our Patient Safety Priorities quarterly update that will be broadcast to all sites on May 29. 


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