This document discusses patient involvement in infection prevention and control efforts. It suggests including patients in decisions about their own care, quality improvement projects, and strategic planning. Examples of how to engage patients include providing them with information via folders, posters and videos. The document also discusses patients' current internet use to research health topics and find support. It notes that while patients may become well-informed, they still need physician guidance. The rest of the document outlines strategies for engaging patients in hand hygiene monitoring and prevention of surgical site infections and UTIs.

1. 20-03-19
1
Andreas Voss, MD, PhD
CWZ and Radboud umc, Nijmegen, The Netherlands

2. 20-03-19
2
patiënt
Include patients at three levels …
• in decisions about their own care
(“decide together”)
• in quality improvement projects and
reflections on quality care
• when formulating strategic plans and
reviewing results with regard to
patient safety

3. 20-03-19
3
¤ Folders, posters, video’s … any kind of delivering information
¤ Serious gaming
¤ Pin/button for HCW (“talk to me”)
¤ Monitor/auditor of e.g. HH compliance
¤ Patient’s hand hygiene
involvement = responsibility?

4. 20-03-19
4
Patients' current use of the internet for three functions:
“seeking information” (currently most often), “mutual support”,
and “care provider contact” (future need)
“Informed patients”.
o well read on the medical condition that they are looking to resolve
o may have often over researched and may be paranoid about what they may be going
through
o may also know all potential medications that may be used for treatment and also
potential side effects of these.
However, they may not – without help from doctor - be in a position to judge what is
actually right and what is actually applicable for what they are going through.

5. 20-03-19
5
I want to be
involved
I want to be
involved
Was it the leg
with or without
the “X” we need
to amputate

6. 20-03-19
6
¤ According to WHO and its Collaborating Centre on Patient
Safety, the University of Geneva Hospitals, patient participation
is considered a useful strategy for improving hand hygiene and
creating a positive patient safety climate in the facilities
implementing it.
¤ Patients and their family members can participate by:
² asking for information about any existing initiatives that involve
patients at the health facility
² asking health workers who are about to touch them to clean their
hands, and thanking them when they do.

7. 20-03-19
7
Pittet et al. JHI. 2011;77:299
¤ 57% of the public were unlikely to question
doctors on the cleanliness of their hands as they
assumed that they had already cleaned them.
¤ 43% of inpatients considered that HCWs should
know to clean their hands and trusted them to do
so
¤ 20% would not want HCWs to think that they were
questioning their professional ability to do their
job correctly
Pittet et al. JHI. 2011;77:299

8. 20-03-19
8
T. Landers et al. AJIC 40 (2012) S11-S17 S13
¤71% of HCWs said that HAI could be reduced if
patients asked HCWs if they had cleaned their hands
before touching them.
¤Inviting patients to remind HCWs about hand hygiene
through the provision of individual alcohol-based
hand-rub containers and actively supporting an ‘It’s
OK to ask’ attitude were perceived as the most useful
interventions by both patients and HCWs.
Pittet et al. JHI. 2011;77:299

9. 20-03-19
9
¤Participation programs (patients asking HCWs if they performed
hand hygiene) can help to increase HCW hand hygiene
compliance
² soap consumption increased by 34% and 50%
² 94% increase in hand hygiene events when patients asked whether
HCWs performed hand hygiene.
¤The long-term sustained effect on hand hygiene compliance and
impact on infection rates remain unknown
McGuckin et al. Am J Infect Control 1999;27:309-14. J Hosp Infect 2001;48:222-7. Am J Infect Control 2004;32:235-8.
¤Role of patients’ hands in the transmission of HAIs has not yet clear
¤Still, the literature strongly reinforces the need for patient hand
hygiene programs

10. 20-03-19
10
¤ After using the toilet, bedpan, or commode
¤ Before eating, drinking, taking medicine, or putting anything in your mouth
¤ When visibly dirty or when there is concern about whether hands are clean
¤ Before touching any breaks in the skin (eg, wounds, dressing, tubes) or any
care procedures (eg, dialysis, IV drug administration, injections)
¤ Before dialysis, contact with IV lines or other tubes
¤ After coughing, sneezing, or touching nose or mouth
¤ Before interacting with visitors and after they leave
¤ When returning to room after test or procedure
T. Landers et al. AJIC 40 (2012) S11-S17 S13
1
What is a Surgical Site Infection
(SSI)?
Surgical site infections (SSIs) are wound infections
that occur after invasive surgical procedure at the
body part where surgery has been performed. These
infections may involve only the skin, or may be more
serious and involve tissue under the skin or organs.
A surgical site infection may cause symptoms such
as: redness, warmth, pain or tenderness around the
affected site, discharge of pus or fever. The majority
of SSIs become apparent within 30 days from the sur-
gical procedure.
Surgical site infection can often be prevented if care is
taken before, during and after surgery.
What are hospitals doing to pre-
vent the occurrence of surgical
site infections?
Hospitals perform surgical site surveillance for specific
operations and can then compare to national levels.
Ask your health care provider information if
they participate in surgical site infection sur-
veillance programme?
As part of the preoperative process, for cardiotho-
racic, orthopaedic or other high risk surgery you will
be screened for Staphylococcus aureus carriage (a
nasal swab will be collected).
If you are a carrier of Staphylococcus aureus
you will need to adhere to treatment with an
ointment and possibly an antiseptic wash for
the recommended duration before and after
your surgery.
You may be prescribed antibiotics to further
reduce the risk of developing an infection. In
most cases, antibiotics will be administered
within 60 minutes before the surgery starts and
should not last for longer than 24 hours follow-
ing surgery.
What can I do to prevent Sur-
gical site infections?
Before the surgery:
Smoking is a known risk factor associated with
complications during and also after the surgical
procedure. People who smoke are prone to de-
veloping more infections after surgery.
It is recommended that you stop smok-
ing 4 weeks or longer before your sur-
gery
Your healthcare provider should be informed of
the following:
Your medical history, particularly in ca-
se of diabetes mellitus.
Your travel history within the last year or
previous recent hospitalisation abroad.
A PATIENT INFORMATION LEAFLET
PREVENTING SURGICAL SITE INFECTIONS
Antimicrob Resistance Infect Control 2017:6:45

11. 20-03-19
11
¤ Staphylococcus aureus screening and decolonization
¤ Smoking
¤ Hair removal
¤ Hand hygiene
¤ Body temperature
¤ Preoperative showering and bathing
¤ DM
¤ Wound care after surgery
¤ Multidrug-resistant organism risk (MDRO)
¤ UTI
²Reducing incidence of UTI by better hydration
²Reminding HCWs that catheter is still in-situ (still needed?)
²Stop possibility for back-flow (bag above bladder level)
¤ CR-BSI
²Reminding HCWs that catheter is still in-situ (still needed?)
² Skin-decolonization by patients

12. 20-03-19
12
¤ Information, information, information (on HAI & IPC)
¤ Create culture of “It’s okay to talk to me”
¤ Monitor/auditor of e.g. HH compliance
¤ Patient’s hand hygiene
¤Study impact of IPC measures on patients
Thank you! Any questions?