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How to Make It Easier for Patients to Speak Up About Hand Hygiene

June 07, 2016



According to an article humans unconsciously touch their noses and mouths more than 3.6 times per hour. When we do this, not only do we spread germs into our bodies from whatever we were touching; we spread germs from our bodies onto whatever we touch next. In the course of a day, we expose ourselves to potential infection – as well as transmit opportunities to infect others – about 86.4 times.


For hospital clinicians, the risks of this unconscious touching of nose or mouth are much higher, they could pass germs on to patients resulting in a healthcare acquired infection (HAI). With HAIs infecting nearly two million patients, causing approximately 100,000 deaths annually in the US, it reinforces the importance of proper hand hygiene when in a healthcare facility.


Over the past two decades, hand hygiene training has become part of the clinician education process. Today, hand washing before and after a clinician touches a patient is mandatory, as it also is before and after entering a patient’s room or touching medical equipment. In fact, many hospitals have compulsory annual online classes for clinicians that include specific directions on correct hand hygiene procedures along with reminder signs posted on hospital walls and screen savers on hospital computers.


So, what happens if you are hospitalized for a medical procedure and notice the clinician touching her nose or mouth and then touching you without washing her hands? Do you speak up or forever hold your peace, hoping that you will come through the procedure without acquiring an infection?


One physician diagnosed with cancer and being prepped for a liver biopsy found herself in this exact situation. The way she tells it, “while one nurse washed my incision site, another nurse prepped the room. She was adjusting the lights, surgical equipment and my gown, and she rubbed her nose with her hand.”


The patient, having been trained on the risk of normal nose bacteria infecting surgical sites while a medical student, wondered if she should say something to the nurse for this gesture. Being in a somewhat compromised position in the nurse’s hands, the patient feared some sort of retribution if she said something to the nurse. Perhaps the nurse wouldn’t treat her well; perhaps the nurse would be upset with her, etc.


A few minutes had passed and the patient decided it was too late to say anything, but told herself that if the nurse rubbed her nose again, she would. And then it happened. The nurse rubbed her nose again, and reached for the equipment table with that same hand. This time, the patient asked the nurse to wash her hands, which she did, even though she denied touching her nose.


After the liver biopsy was performed, the patient acquired a bloodstream infection. Subsequently, it was determined that cancer cells in the liver can host a certain bacteria and after a liver biopsy, it is not uncommon for these bacteria to infect the bloodstream. But before the patient knew which bacteria had infected her blood, she logically worried that it might have been bacteria from the nurse’s nose.


At issue here is this: Most patients, particularly those who are ill, can feel intimidated about calling a doctor or nurse out on a mistake in procedure, whether real or perceived. Sick patients should not be expending their mental energy wondering if speaking up for themselves could have improved their outcomes. And, when they do speak up, they should not have to worry that a nurse or doctor might be angry with them for doing so.


Following are a few tips for how patients can speak up at the hospital:


  • Be clear about what is wrong and what you believe needs to be done;
  • Speak immediately and be polite yet assertive.
  • If the concern was not resolved on the spot, contact hospital’s customer service or patient relations department after the visit.

When patients speak up, they need to know errors will be acknowledged and remedied without retribution. And, the lesson learned from this patient is quite clear: those in healthcare need to take responsibility and make safety a part of their culture. This includes rewarding safety when appropriate and providing negative feedback when deserved. When patients are assertive, clinicians must be respectful and take action. When they aren’t, it should only be because all matters of safety have been carefully and thoughtfully attended to – including hand hygiene.


Originally posted by DebMed on Apr 28, 2016 9:30:00 AM


About DebMed:

is the creator of an electronic hand hygiene compliance monitoring system based on the World Health Organization (WHO)'s "Five Moments for Hand Hygiene" and is now the only hand hygiene system that meets the WHO's "Save Lives: Clean Your Hands" recommendation. DebMed GMS encourages increased hand hygiene among hospital staff, thereby reducing the risk of spreading the flu virus and other infectious diseases between patients and improving patient safety and care.


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