CDC: Tell patients to ask HCWs to wash their hands

Video shown on admission promotes hand hygiene

"Hello. I'm Dr. John Jernigan from the Centers for Disease Control and Prevention. Your doctor has chosen to admit you to this facility because you need high-quality medical care. The health care providers here want to do everything they can to help you get well and to avoid complications.

"You came to the hospital to get well, but you should know that each year in the United States, patients get more than a million infections in the hospital while they're being treated for something else.

"Examples of infections patients can get in the hospital include infections in their bloodstream, surgical wound, or urinary tract, as well as pneumonia.

"These infections can be serious and hard to treat, but there's one simple thing you and your family can do to help prevent these infections: Wash your hands and make sure that everyone who touches you — including your doctor — cleanses their hands, too ..."

Think of this as the hospital version of the "safety talk" when passengers board an airplane. Hospitals around the country have begun to use a new, free five-minute video created by the CDC and cosponsored by the Association for Professionals in Infec-tion Control and Epidemiology (APIC) and the CDC Foundation.

The main message: Patients should politely demand that their caregivers clean their hands before they touch them.

"What we're hoping to achieve is a culture change," says Kristin Rainisch, MPH, health communications specialist with CDC's Division of Healthcare Quality Promotion. "You should wash your hands when you're in a health care facility. It's as important as washing your hands before you eat or when you use the restroom."

Bill Borwegen, MPH, occupational safety and health director for the Service Employees International Union (SEIU), supports the concept of encouraging patients to remind health care workers to wash their hands. But he says that's just one component of an effort to fight hospital-acquired infections and improve hand hygiene compliance. "It's a systemic problem that's the result of a lack of a safety culture in the institution," Borwegen says.

Rainisch agrees that the video reminder should be part of a comprehensive approach. "It's just one tool in the toolkit to help prevent health care-associated infections," she says.

Infection tragedy leads to safety campaign

The inspiration for the instructional video actually came from the mother of a patient who died from a health-care associated infection. Josh Nahum, 27, a skydiving instructor in Colorado, fractured his leg and skull in a hard landing; but at first his recovery seemed assured. He fought off a staph infection in the intensive care unit and moved to a rehab unit, where he was making progress.

Then Josh developed an aggressive infection with Enterobacter aerogenes in his cerebrospinal fluid. The pressure of the infection pushed brain matter into his spinal column, causing paralysis. He died two weeks later — not from his injuries, but from his health care-acquired infection.

His parents were in shock. As they learned more about health care-acquired infections, they began to speak out and created an organization to spread awareness, the Safe Care Campaign (www.safecarecampaign.org).

"Once a patient gets an infection, that's a dark hole you don't want to be in," says Victoria Nahum, Josh's mother. "You would rather prevent one than control one because they're not easily controlled."

Nahum had a sudden epiphany when she was sitting aboard a plane, waiting to travel to a speaking engagement. Why do we hear repeated information about safety on airplanes but none in hospitals? Couldn't patients be engaged to participate in their own safety?

The CDC agreed to produce the video, and APIC and Kimberly-Clark Health Care in Roswell, GA, became sponsors. Thousands of videos have been provided to hospitals around the county.

In the video, a patient asks a physician to wash her hands. She responds that she washed them before she came into the room. The patient presses the point, telling her she wants to see her wash her hands.

It is designed to help patients overcome their timidity about confronting their health care providers. A survey of health care consumers found that only one in four (25.9%) were likely to ask providers to wash their hands.1

"I myself would feel uncomfortable asking a health care provider," says Rainisch. "That's one of the things we try to address in the video by showing scenarios. The people who watch the video can see the behavior being modeled. It's a way of almost scripting the information for them. They can also see the results it yields [when the doctor readily washes her hands]."

Hand hygiene is an important strategy in the battle against health care-acquired infections, says Nahum. "Our message to health caregivers is that every single thing they do matters," she says. "One time that you wash your hands when you weren't going to, these things matter with enormous consequences."

(Editor's note: A copy of the video is available at www.cdc.gov/handhygiene/Patient_Admission_Video. html. A eight-minute employee education video, "It's in Your Hands," is available from BD of Franklin Lakes, NJ, at www.cdc.gov/handhygiene/Patient_Admission _Video.html.)

Reference

1. Marella WB, Finley E, Thomas A, et al. Health care consumers' inclination to engage in selected patient safety practices: A survey of adults in Pennsylvania. J Patient Saf 2007; 3:184-189.