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New hand hygiene auditing approach engages patients to play active role in their own healthcare

June 24, 2013

Diligent hand hygiene practices are important to patient and staff safety in all hospitals.  As recommended by the World Health Organization, Women’s College Hospital (WCH) utilizes a direct observer approach in select clinics and departments to monitor and encourage healthcare provider hand hygiene compliance. In searching for an alternative hand hygiene auditing method that better addresses unique challenges, the Infection Prevention & Control (IP&C) department tested the possibility of patient involvement through the Patient-as-Observer (PAO) Approach. 

The PAO Approach, adapted and customized from a method used at Johns Hopkins Hospital, is being explored at WCH in the Family Practice Health Centre (FPHC). Led by the FPHC Yellow A team, the pilot successfully concluded after ten months. The results proved what was expected: engaging staff and patients in encouraging hand hygiene compliance is a useful approach.

“This project has provided us with another brilliant opportunity to engage the patient as an active participant in their healthcare,” said Jennifer Dockery, director of primary care at WCH.

The PAO Approach is a simple process. After a patient registers at check-in upon arrival for her/his appointment, a volunteer issues a survey card and provides brief instructions. The patient is asked to observe whether their healthcare providers clean their hands before providing care. Upon leaving the clinic, the patient fills out the survey card and returns it to the volunteer.  

“Participating in the PAO Approach didn’t affect our already-in-place work routines in the slightest,” said Dr. Susie Kim, Yellow A team physician, FPHC.  “It made everything a little easier and clarified any unsaid worries patients had about hand hygiene.”

Overall, Yellow A team staff and physicians agree that the pilot was a great tool for keeping up with a quick, thorough hand-washing routine.  Doing so in front of patients as opposed to outside of the exam room isn’t any extra work or hassle, they noted.

The Yellow A team is helping WCH lead ambulatory care innovation. The findings of the pilot were presented during a Safer Healthcare Now! national webinar conference call in April and at the Community and Hospital Infection Control Association’s National Education Conference earlier this month.

“Both presentations were very well-received and it is so great to hear that various hospitals, home care sites and ambulatory care clinics have expressed their interest in potentially adapting this approach in their own setting,” added Sheila Le-Abuyen, IP&C practitioner and IP&C lead for the PAO Approach in FPHC. 

Future dissemination avenues include a scheduled presentation at the Canadian Association of Ambulatory Care Conference in September and submission of a journal manuscript. 

To follow up on the successful conclusion of the pilot, work has begun on gradually expanding the PAO Approach to involve the rest of the FPHC teams.  The IP&C team hopes that in the near future, other WCH clinics and departments will want to adopt this PAO Approach, innovating the way that patients play a role in their own healthcare at WCH.

Patient-as-Observer Approach
From left to right: Bibi Khan, receptionist (left), Anne De La Franier, nurse (centre), and Dr. Sapna Jha, physician (right) of Yellow A Team at FPHC took part in the Patient-as-Observer Approach pilot at WCH.


Patient-as-Observer Approach
Anne De La Franier, nurse (left) and Dr. Susie Kim, physician (right) both agree that the Patient-as-Observer Approach pilot was easy, effective and a success.
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