Case Western Reserve University nurse scientist explains why hand hygiene is important for patients, not just doctors and nurses, in hospital setting

A clinical researcher who has studied the lack of hygiene practices among hospital patients is urging hospitals—and those who end up there—to do more to fight against the novel coronavirus, which had infected more than 2 million people worldwide by mid-April.

And, yes, it again starts with simple, but critical, hand hygiene.

Shanina Knighton

“There are decades of research showing that patients know hand hygiene is important but often rely heavily on health-care staff to tell them to practice,” said Shanina Knighton, a clinical nurse scientist and infection preventionist at the Frances Payne Bolton School of Nursing at Case Western Reserve University.

Many patients assume hand-hygiene products, such as wall dispensers in hospitals, are meant for health-care workers—not for them, she said. The patients’ role in preventing infection in hospitals is often ignored despite recent reports that the highest concentrations of COVID-19 virus were found on the floors, doorknobs, bed rails, trash cans and other high-contact areas. “Patients will come in contact with these surfaces often,” she said.

Another recent study looked showed how much a small sample of a mock-virus can contaminate an entire room, making the need for aggressive hygiene even more apparent.

But patients—who, of course, also carry germs on their hands, including viruses—generally have either poor hygiene practices or don’t clean their hands at all while being treated, Knighton said.

This means that doctors, nurses and hospital workers may follow specific hygiene protocols but can still be exposed to patients and their visitors. Many patients either aren’t aware of how to best protect themselves or are just not taking action to stay safe.

“That’s because health-care workers are required to practice, but it is optional for the patient—despite its importance,” Knighton said. “This is a huge gap in our protection against spreading germs, especially knowing that as few as 8% of patients practice.” 

Four ‘moments’ to wash your hands in hospital
 
In 2016, Prevention Strategist magazine published Knighton’s practical steps for getting hospital patients to washing their hands.   
 
In addition to asking health-care workers to clean their hands, she makes suggestions for patients during COVID19 to take preventative steps and clean their hands during what she and her colleagues call critical “moments:”
 
1.   Avoid wearing jewelry on wrists and fingers. Bacteria can hide under small surfaces such as rings or watches. Also if you have to remove them at any point you can risk sitting them on contaminated surfaces. Avoid taking them to hospital facilities.
 
2. Take hand sanitizer or wipes with you that will be easy for you to use. This will prevent you from having to ask for assistance if you can’t safely get out of bed. You may have to if you don’t have these resources.
 
3.  Feel comfortable using the hand sanitizer located in the room if you can get out of bed safely.
 
4. Clean your hands… 
a. when entering and exiting your room
b. before eating your food
c. after using the restroom
d. before and after touching wounds
e. before and after touching devices, surfaces such as your bedrails. (It is ok to ask that they be cleaned). 
f. whenever they feel or look dirty

Further, Knighton said, most hospitals only provide patients with a lemon towelette on their meal tray and assume patients use the sinks, wall hand-sanitizer dispensers and clean their hands. We have to address barriers that prohibit patients from cleaning their hands.

Lack of policy, practice for patients

And there are no federally mandated policies, widespread practices or even broadly shared recommendations to address patient hand hygiene as a prevention strategy, or for the removal of hospital germs from patients’ hands, she said.

So far, the World Health Organization only recommends patients to ask health-care staff to practice hand hygiene—not for patients to practice hand hygiene themselves, Knighton said. 

And while the Centers for Disease Control provides a “Clean Hands Count for Patients,” and some hospital systems provide materials electronically on their websites, health-care facilities are not required to provide patient hand-hygiene education materials.

Knighton said this disparity first became apparent to her during the 2009 H1N1 Swine flu epidemic.

While working as a bedside nurse, she noticed that patients would sneeze and cough without covering their mouth or coughing into their elbow, that their bedside table was littered with used tissues and that they would sometimes have to place their portable urinal on the same table where they ate their meals.

Knighton then began to develop a body of scientific work to study the patients’ role in infection transmission and ways to help patients become more independent with cleaning their hands in hospitals.


For more information, contact Mike Scott at mike.scott@case.edu