American Journal of Infection Control 43 (2015) 510-5
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Major article
Discrepancy in perceptions regarding patient participation in hand hygiene between patients and health care workers Min-Kyung Kim MD a, b, Eun Young Nam MD a, Sun Hee Na MD a, Myoung-jin Shin RN c, Hyun Sook Lee RN d, Nak-Hyun Kim MD a, Chung-Jong Kim MD a, b, Kyoung-Ho Song MD a, b, Pyoeng Gyun Choe MD a, Wan Beom Park MD a, Ji-Hwan Bang MD a, Eu Suk Kim MD a, b, Sang Won Park MD a, Nam Joong Kim MD a, Myoung-don Oh MD a, Hong Bin Kim MD a, b, c, * a
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Republic of Korea c Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea d Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Republic of Korea b
Key Word: Health care-associated infection Hand disinfection Patient empowerment Physician-patient relation
Background: Patient participation in hand hygiene programs is regarded as an important component of hand hygiene improvement, but the feasibility of the program is still largely unknown. We examined the perceptions of patients/families and health care workers (HCWs) with regard to patient participation in hand hygiene. Methods: A cross-sectional survey of patients/families as well as physicians and nurses was performed using an anonymous, self-administered questionnaire in a 1,000-bed teaching hospital in South Korea. Results: A total of 152 physicians, 387 nurses, and 334 patients/families completed the survey. The overall response rate was 84%, 85%, and more than 60% among physicians, nurses, and patients/families, respectively. Whereas 75% of patients/families wished to ask HCWs to clean their hands if they did not do so themselves, only 26% of physicians and 31% of nurses supported the participation of patients (P < .001). The most common reason why HCWs disagreed with patient participation was concern about negative effects on their relationship with patients (54%). Regarding the method of patient involvement, patients preferred to assess hand hygiene performance, whereas physicians preferred patients to ask directly. Conclusions: There was a significant discrepancy in perceptions regarding patient participation between patients/families and HCWs. Enhanced understanding and acceptance of any new program by both patients and HCWs before its introduction are needed for successful implementation. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Hand hygiene (HH) is regarded as the most effective measure for preventing the spread of infection in health-care settings.1 Patient participation (PP), or patient empowerment, a new concept derived from self-management of chronic disease,2 has been expanded to patient safety issues and recently applied to HH promotion.3 It
* Address correspondence to Hong Bin Kim, MD, Department of Internal Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea. E-mail address: [email protected] (H.B. Kim). This work was supported by a grant from the Korea Centers for Disease Control and Prevention (grant no. 2012E2101200). Conflicts of interest: None to report.
implies that patients can be involved in improving the compliance of health care workers (HCWs) with HH by reminding them to wash their hands. Patient empowerment has been adopted as 1 component of the World Health Organization (WHO) guidelines.4 Incidentally, the guidelines for HH in health care settings established by the US Centers for Disease Control and Prevention,5 and the “please ask” campaign initiated by the National Patient Safety Agency in the United Kingdom both urge patients to ask health care providers to wash their hands.6 Although major health care authorities have already recommended PP to improve HH, and early studies report that patient engagement increases HH compliance by HCWs,7,8 questions still remain about whether PP is feasible and acceptable to both HCWs
0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.01.018
M.-K. Kim et al. / American Journal of Infection Control 43 (2015) 510-5
and patients in actual hospital settings. Studies have shown that patients are willing to be engaged,9,10 and that an explicit invitation by HCWs can increase patients’ intention to intervene with HCWs.10,11 Those studies suggest that acceptance by HCWs is important for successful implementation of PP. However, the few studies that have focused on HCWs’ perspectives have yielded inconsistent results. Various methods such as wearing aprons saying, “It’s OK to ask,”12 or using an electronic reminding device13 have been suggested to help patients feel comfortable discussing HH with HCWs, which implies that additional methods may be needed to encourage PP. We postulated that neither patients/families nor HCWs would feel free to accept PP given the current vertical HCW-patient relationship, and that less direct methods are needed for patients and HCWs to willingly accept PP. We therefore conducted a hospitalbased survey to examine perceptions and willingness of patients/ families and HCWs regarding PP in HCWs’ HH in a practical clinical setting. We also sought methods other than direct asking with which both sets of stakeholders might feel more comfortable. METHODS Study design We performed a cross-sectional survey of inpatients and families as well as physicians and nurses at a single hospital using an anonymous, self-administered questionnaire during April 2013. Our institution is a tertiary teaching hospital with 1,000 beds in South Korea, which has intensively introduced the multimodal approaches of the WHO HH guidelines other than patient participation, and has achieved a sustained HH compliance rate of more than 80% since 2012. The study protocol was approved by our institutional review board (No. B-1303-196-302). Study patients We targeted all the hospitalized patients or their families as potential participants, excluding patients in the intensive care unit, emergency department, and psychiatric department. Patients who were too ill or cognitively impaired as well as illiterate, or had poor vision were excluded. A single researcher visited and asked all the hospitalized patients or their families in all eligible departments to complete the paper-based survey at the bedside. Patients were asked first and, if a patient was reluctant or was not available to answer the questions, then a family member was asked. We also excluded those who were absent due to examinations, procedure, or surgery when the researcher visited. Caregivers hired to take care of patients were not enrolled. We included all the registered nurses, head nurses, interns, and resident physicians who care for patients in general wards as study participants and excluded those HCWs who worked only in the intensive care unit, emergency department, outpatient clinic, or psychiatric wards; or belonged to departments without admitted patients, such as clinical pathology, radiology, nuclear medicine, or radiation oncology. The questionnaires were distributed to physicians by the chief or vice-chief resident physician of each department, and to nurses by the head nurse in each ward. Patients were assigned to medical, surgical, and mixed department categories. Interns and nurses who worked in wards with both medical and surgical components were classified as mixed. Survey questionnaires Two questionnaires were developed based on prior research10,11,14 and the WHO Patient Safety Hand Hygiene Survey.15
511
They were reviewed by infectious disease physicians and infection control professionals in our institution, and revised after pretesting with 10 patients and HCWs. The questionnaire for patients/families consisted of 9 HH-related questions and 8 demographic questions. The first part was designed to assess patients’ awareness of the importance of HH, assessment of current HH status, wish and actual intent to ask HCWs to perform HH, and reasons for hesitating to ask, and preferred method of PP. The other part comprised basic demographic data (ie, age, gender, education level, and selfreported economic status), status as patient or family member, length of hospital stay, admitted department, and experience of health care-associated infection (HAI). The questionnaire for HCWs consisted of 10 HH-related questions: basic perception of the importance of HH and HAI, self-assessment of HH compliance and reasons for noncompliance with HH, attitude toward PP, anticipated positive effect of PP, reasons in case of disagreement with PP, and preferred method of PP, along with 5 questions about demographic information: age, sex, profession, work experience, and affiliated department. Most items were closed-ended 5-point Likert scale questions, but some were graded on a 10-point scale to specify the results more accurately. Some questions such as reasons were asked via multiple choices. Statistical analysis Five-point scale responses were presented as frequencies by grouping agree (“strongly agree” and “agree”), neutral, and disagree (“strongly disagree” and “disagree”). Ten-point scale responses were analyzed as continuous variables with mean, median, and standard deviation to fulfill their original purpose, which was to measure opinions more accurately than could be achieved on a 5point scale. Cronbach’s a was > 0.8 for the PP-related questions among patients, and > 0.7 for basic perceptions of HH and HAI, and PP-related questions among HCWs. Categorical variables were compared using Pearson c2 or Fisher exact test. The Student t test and the 1-way analysis of variance were used to compare continuous variables, and paired Student t test was used to analyze differences between patients’ wishes versus their actual intentions to ask HCWs to wash their hands. All analyses were 2-tailed and a P value < .05 was considered significant. All data were analyzed using SPSS version 19.0 (IBM-SPSS Inc, Armonk, NY). RESULTS Responding patients/families and HCWs The daily mean number of hospitalized patients at the time of the survey, excluding patients in the intensive care unit, emergency department, and psychiatric department, was 896. However, some patients were excluded for the following reasons: absence from their rooms for various reasons (23%), being too ill to respond to the survey (9%), or being cared for by hired caregivers in place of families (6%). Finally, a total of 334 patients/families participated in the survey, consisting of 148 patients (148 out of 334; 44%), 177 family members (177 out of 334; 53%), and 9 unclassified subjects (9 out of 334; 3%). The estimated response rate of the eligible candidates exceeded 60%. The total number of eligible HCWs was 181 physicians and 454 nurses. Of these, 152 physicians and 387 nurses completed the survey. The response rate was 84% for the physicians and 85% for the nurses. Characteristics of the respondents are summarized in Table 1. More than 90% of the patients/families had high school or university diplomas. Only 21 patients and family members had a previous experience of HAI. Most patients/families (80%) had
512
M.-K. Kim et al. / American Journal of Infection Control 43 (2015) 510-5
Table 1 Demographic characteristics of 148 patients, 177 family members, 152 physicians, and 387 nurses who completed the survey Characteristic
Patients who responded
Sex Male Female Age, y Education level Middle school or below High school University degree or higher Self-reported economic status Low Middle High Admitted or working department Medical* Surgicaly Mixedz Length of hospitalization, d 14 15-29 30 Previous experience of health care-associated infection Grade in physicians/WE in nurses Intern/WE < 2 y First- or second-year resident physician/2 WE < 5 y Third- or fourth-year resident physician /WE 5 y Previous experience of being asked to perform hand hygiene by patients
Family members who responded
Physicians who responded
Nurses who responded
83/148 (56) 65/148 (44) 48 (17-83)
51/175 (29) 124/175 (71) 46 (20-67)
89/148 (59) 59/148 (39) 29 (25-35)
0/387 (0) 386/387 (100) 29 (23-50)
13/142 (9) 53/142 (37) 76/142 (54)
6/173 (4) 47/173 (27) 120/173 (69)
-
-
14/146 (10) 110/146 (75) 11/146 (15)
13/171 (8) 130/171 (76) 28/171 (16)
-
-
64/147 (44) 83/147 (57) -
101/176 (57) 75/176 (43) -
122/148 18/148 8/148 6/139
(82) (12) (5) (4)
139/176 24/176 13/176 15/173
59/152 (39) 68/152 (45) 25/152 (16)
(79) (14) (7) (9)
163/387 (42) 142/387 (37) 82/387 (21)
-
-
-
-
25/145 (17) 67/145 (46)
59/383 (15) 163/383 (43)
-
-
53/145 (37)
161/383 (42)
-
-
22/151 (15)
16/383 (4)
NOTE. The denominator was different according to each item because only respondents who answered the question were included. Values are presented as proportion (%) or median (range). WE, work experience. *Includes internal medicine, pediatrics, neurology, rehabilitation medicine, dermatology, and family medicine. y Includes general surgery, orthopedics, obstetrics and gynecology, thoracic surgery, neurosurgery, urology, otolaryngology, plastic surgery, and ophthalmology. z Includes interns and nurses who worked in wards composed of both medical and surgical departments.
Table 2 Perceptions and intentions of patients and families regarding hand hygiene and patient participation Patients who responded Questions Do you usually observe if HCWs perform HH? Do HCWs in our institution fully comply with HH? Should patients or families be aware whether or not HCWs wash their hands? Is patient participation effective in enhancing HCWs’ HH adherence? Do you wish patients/families to ask HCWs to perform HH if they did not? Do you think HCW HH is important?* How likely is it that you will ask 1 of the following HCWs to perform HH if he/she did not?* Professor Resident physician/intern Nurse
Families who responded
n
Strongly agree or agree
Neutral
Strongly disagree or disagree
n
Strongly agree or agree
Neutral
Strongly disagree or disagree
P value
145
84 (58)
31 (21)
30 (21)
173
109 (63)
44 (25)
20 (12)
.08
135
114 (85)
18 (13)
3 (2)
157
122 (61)
27 (15)
8 (4)
.26
144
109 (76)
19 (13)
16 (11)
172
145 (84)
17 (10)
10 (6)
.13
141
98 (70)
34 (24)
9 (6)
162
123 (76)
31 (19)
8 (5)
.45
147
108 (73)
27 (18)
12 (8)
166
127 (79)
29 (18)
10 (6)
.73
147
9.1 (10) 1.7
176
9.4 (10) 1.3
.06
141 139 140
6.0 (6) 2.8 6.1 (6) 2.7 6.3 (6.5) 2.8
161 163 164
5.6 (5) 2.9 6.0 (6) 2.9 6.3 (6) 2.85
.27 .72 .99
NOTE. Values are given as n (%) or mean (median) standard deviation. HCW, health care worker; HH, hand hygiene. *Composed of 10-point scale responses that were analyzed as continuous variables with mean, median, and standard deviation. The others were 5-point scale questions, shown as categorical variables with frequencies (percentages).
hospital stays of
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Major article
Discrepancy in perceptions regarding patient participation in hand hygiene between patients and health care workers Min-Kyung Kim MD a, b, Eun Young Nam MD a, Sun Hee Na MD a, Myoung-jin Shin RN c, Hyun Sook Lee RN d, Nak-Hyun Kim MD a, Chung-Jong Kim MD a, b, Kyoung-Ho Song MD a, b, Pyoeng Gyun Choe MD a, Wan Beom Park MD a, Ji-Hwan Bang MD a, Eu Suk Kim MD a, b, Sang Won Park MD a, Nam Joong Kim MD a, Myoung-don Oh MD a, Hong Bin Kim MD a, b, c, * a
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Republic of Korea c Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea d Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Republic of Korea b
Key Word: Health care-associated infection Hand disinfection Patient empowerment Physician-patient relation
Background: Patient participation in hand hygiene programs is regarded as an important component of hand hygiene improvement, but the feasibility of the program is still largely unknown. We examined the perceptions of patients/families and health care workers (HCWs) with regard to patient participation in hand hygiene. Methods: A cross-sectional survey of patients/families as well as physicians and nurses was performed using an anonymous, self-administered questionnaire in a 1,000-bed teaching hospital in South Korea. Results: A total of 152 physicians, 387 nurses, and 334 patients/families completed the survey. The overall response rate was 84%, 85%, and more than 60% among physicians, nurses, and patients/families, respectively. Whereas 75% of patients/families wished to ask HCWs to clean their hands if they did not do so themselves, only 26% of physicians and 31% of nurses supported the participation of patients (P < .001). The most common reason why HCWs disagreed with patient participation was concern about negative effects on their relationship with patients (54%). Regarding the method of patient involvement, patients preferred to assess hand hygiene performance, whereas physicians preferred patients to ask directly. Conclusions: There was a significant discrepancy in perceptions regarding patient participation between patients/families and HCWs. Enhanced understanding and acceptance of any new program by both patients and HCWs before its introduction are needed for successful implementation. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Hand hygiene (HH) is regarded as the most effective measure for preventing the spread of infection in health-care settings.1 Patient participation (PP), or patient empowerment, a new concept derived from self-management of chronic disease,2 has been expanded to patient safety issues and recently applied to HH promotion.3 It
* Address correspondence to Hong Bin Kim, MD, Department of Internal Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea. E-mail address: [email protected] (H.B. Kim). This work was supported by a grant from the Korea Centers for Disease Control and Prevention (grant no. 2012E2101200). Conflicts of interest: None to report.
implies that patients can be involved in improving the compliance of health care workers (HCWs) with HH by reminding them to wash their hands. Patient empowerment has been adopted as 1 component of the World Health Organization (WHO) guidelines.4 Incidentally, the guidelines for HH in health care settings established by the US Centers for Disease Control and Prevention,5 and the “please ask” campaign initiated by the National Patient Safety Agency in the United Kingdom both urge patients to ask health care providers to wash their hands.6 Although major health care authorities have already recommended PP to improve HH, and early studies report that patient engagement increases HH compliance by HCWs,7,8 questions still remain about whether PP is feasible and acceptable to both HCWs
0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.01.018
M.-K. Kim et al. / American Journal of Infection Control 43 (2015) 510-5
and patients in actual hospital settings. Studies have shown that patients are willing to be engaged,9,10 and that an explicit invitation by HCWs can increase patients’ intention to intervene with HCWs.10,11 Those studies suggest that acceptance by HCWs is important for successful implementation of PP. However, the few studies that have focused on HCWs’ perspectives have yielded inconsistent results. Various methods such as wearing aprons saying, “It’s OK to ask,”12 or using an electronic reminding device13 have been suggested to help patients feel comfortable discussing HH with HCWs, which implies that additional methods may be needed to encourage PP. We postulated that neither patients/families nor HCWs would feel free to accept PP given the current vertical HCW-patient relationship, and that less direct methods are needed for patients and HCWs to willingly accept PP. We therefore conducted a hospitalbased survey to examine perceptions and willingness of patients/ families and HCWs regarding PP in HCWs’ HH in a practical clinical setting. We also sought methods other than direct asking with which both sets of stakeholders might feel more comfortable. METHODS Study design We performed a cross-sectional survey of inpatients and families as well as physicians and nurses at a single hospital using an anonymous, self-administered questionnaire during April 2013. Our institution is a tertiary teaching hospital with 1,000 beds in South Korea, which has intensively introduced the multimodal approaches of the WHO HH guidelines other than patient participation, and has achieved a sustained HH compliance rate of more than 80% since 2012. The study protocol was approved by our institutional review board (No. B-1303-196-302). Study patients We targeted all the hospitalized patients or their families as potential participants, excluding patients in the intensive care unit, emergency department, and psychiatric department. Patients who were too ill or cognitively impaired as well as illiterate, or had poor vision were excluded. A single researcher visited and asked all the hospitalized patients or their families in all eligible departments to complete the paper-based survey at the bedside. Patients were asked first and, if a patient was reluctant or was not available to answer the questions, then a family member was asked. We also excluded those who were absent due to examinations, procedure, or surgery when the researcher visited. Caregivers hired to take care of patients were not enrolled. We included all the registered nurses, head nurses, interns, and resident physicians who care for patients in general wards as study participants and excluded those HCWs who worked only in the intensive care unit, emergency department, outpatient clinic, or psychiatric wards; or belonged to departments without admitted patients, such as clinical pathology, radiology, nuclear medicine, or radiation oncology. The questionnaires were distributed to physicians by the chief or vice-chief resident physician of each department, and to nurses by the head nurse in each ward. Patients were assigned to medical, surgical, and mixed department categories. Interns and nurses who worked in wards with both medical and surgical components were classified as mixed. Survey questionnaires Two questionnaires were developed based on prior research10,11,14 and the WHO Patient Safety Hand Hygiene Survey.15
511
They were reviewed by infectious disease physicians and infection control professionals in our institution, and revised after pretesting with 10 patients and HCWs. The questionnaire for patients/families consisted of 9 HH-related questions and 8 demographic questions. The first part was designed to assess patients’ awareness of the importance of HH, assessment of current HH status, wish and actual intent to ask HCWs to perform HH, and reasons for hesitating to ask, and preferred method of PP. The other part comprised basic demographic data (ie, age, gender, education level, and selfreported economic status), status as patient or family member, length of hospital stay, admitted department, and experience of health care-associated infection (HAI). The questionnaire for HCWs consisted of 10 HH-related questions: basic perception of the importance of HH and HAI, self-assessment of HH compliance and reasons for noncompliance with HH, attitude toward PP, anticipated positive effect of PP, reasons in case of disagreement with PP, and preferred method of PP, along with 5 questions about demographic information: age, sex, profession, work experience, and affiliated department. Most items were closed-ended 5-point Likert scale questions, but some were graded on a 10-point scale to specify the results more accurately. Some questions such as reasons were asked via multiple choices. Statistical analysis Five-point scale responses were presented as frequencies by grouping agree (“strongly agree” and “agree”), neutral, and disagree (“strongly disagree” and “disagree”). Ten-point scale responses were analyzed as continuous variables with mean, median, and standard deviation to fulfill their original purpose, which was to measure opinions more accurately than could be achieved on a 5point scale. Cronbach’s a was > 0.8 for the PP-related questions among patients, and > 0.7 for basic perceptions of HH and HAI, and PP-related questions among HCWs. Categorical variables were compared using Pearson c2 or Fisher exact test. The Student t test and the 1-way analysis of variance were used to compare continuous variables, and paired Student t test was used to analyze differences between patients’ wishes versus their actual intentions to ask HCWs to wash their hands. All analyses were 2-tailed and a P value < .05 was considered significant. All data were analyzed using SPSS version 19.0 (IBM-SPSS Inc, Armonk, NY). RESULTS Responding patients/families and HCWs The daily mean number of hospitalized patients at the time of the survey, excluding patients in the intensive care unit, emergency department, and psychiatric department, was 896. However, some patients were excluded for the following reasons: absence from their rooms for various reasons (23%), being too ill to respond to the survey (9%), or being cared for by hired caregivers in place of families (6%). Finally, a total of 334 patients/families participated in the survey, consisting of 148 patients (148 out of 334; 44%), 177 family members (177 out of 334; 53%), and 9 unclassified subjects (9 out of 334; 3%). The estimated response rate of the eligible candidates exceeded 60%. The total number of eligible HCWs was 181 physicians and 454 nurses. Of these, 152 physicians and 387 nurses completed the survey. The response rate was 84% for the physicians and 85% for the nurses. Characteristics of the respondents are summarized in Table 1. More than 90% of the patients/families had high school or university diplomas. Only 21 patients and family members had a previous experience of HAI. Most patients/families (80%) had
512
M.-K. Kim et al. / American Journal of Infection Control 43 (2015) 510-5
Table 1 Demographic characteristics of 148 patients, 177 family members, 152 physicians, and 387 nurses who completed the survey Characteristic
Patients who responded
Sex Male Female Age, y Education level Middle school or below High school University degree or higher Self-reported economic status Low Middle High Admitted or working department Medical* Surgicaly Mixedz Length of hospitalization, d 14 15-29 30 Previous experience of health care-associated infection Grade in physicians/WE in nurses Intern/WE < 2 y First- or second-year resident physician/2 WE < 5 y Third- or fourth-year resident physician /WE 5 y Previous experience of being asked to perform hand hygiene by patients
Family members who responded
Physicians who responded
Nurses who responded
83/148 (56) 65/148 (44) 48 (17-83)
51/175 (29) 124/175 (71) 46 (20-67)
89/148 (59) 59/148 (39) 29 (25-35)
0/387 (0) 386/387 (100) 29 (23-50)
13/142 (9) 53/142 (37) 76/142 (54)
6/173 (4) 47/173 (27) 120/173 (69)
-
-
14/146 (10) 110/146 (75) 11/146 (15)
13/171 (8) 130/171 (76) 28/171 (16)
-
-
64/147 (44) 83/147 (57) -
101/176 (57) 75/176 (43) -
122/148 18/148 8/148 6/139
(82) (12) (5) (4)
139/176 24/176 13/176 15/173
59/152 (39) 68/152 (45) 25/152 (16)
(79) (14) (7) (9)
163/387 (42) 142/387 (37) 82/387 (21)
-
-
-
-
25/145 (17) 67/145 (46)
59/383 (15) 163/383 (43)
-
-
53/145 (37)
161/383 (42)
-
-
22/151 (15)
16/383 (4)
NOTE. The denominator was different according to each item because only respondents who answered the question were included. Values are presented as proportion (%) or median (range). WE, work experience. *Includes internal medicine, pediatrics, neurology, rehabilitation medicine, dermatology, and family medicine. y Includes general surgery, orthopedics, obstetrics and gynecology, thoracic surgery, neurosurgery, urology, otolaryngology, plastic surgery, and ophthalmology. z Includes interns and nurses who worked in wards composed of both medical and surgical departments.
Table 2 Perceptions and intentions of patients and families regarding hand hygiene and patient participation Patients who responded Questions Do you usually observe if HCWs perform HH? Do HCWs in our institution fully comply with HH? Should patients or families be aware whether or not HCWs wash their hands? Is patient participation effective in enhancing HCWs’ HH adherence? Do you wish patients/families to ask HCWs to perform HH if they did not? Do you think HCW HH is important?* How likely is it that you will ask 1 of the following HCWs to perform HH if he/she did not?* Professor Resident physician/intern Nurse
Families who responded
n
Strongly agree or agree
Neutral
Strongly disagree or disagree
n
Strongly agree or agree
Neutral
Strongly disagree or disagree
P value
145
84 (58)
31 (21)
30 (21)
173
109 (63)
44 (25)
20 (12)
.08
135
114 (85)
18 (13)
3 (2)
157
122 (61)
27 (15)
8 (4)
.26
144
109 (76)
19 (13)
16 (11)
172
145 (84)
17 (10)
10 (6)
.13
141
98 (70)
34 (24)
9 (6)
162
123 (76)
31 (19)
8 (5)
.45
147
108 (73)
27 (18)
12 (8)
166
127 (79)
29 (18)
10 (6)
.73
147
9.1 (10) 1.7
176
9.4 (10) 1.3
.06
141 139 140
6.0 (6) 2.8 6.1 (6) 2.7 6.3 (6.5) 2.8
161 163 164
5.6 (5) 2.9 6.0 (6) 2.9 6.3 (6) 2.85
.27 .72 .99
NOTE. Values are given as n (%) or mean (median) standard deviation. HCW, health care worker; HH, hand hygiene. *Composed of 10-point scale responses that were analyzed as continuous variables with mean, median, and standard deviation. The others were 5-point scale questions, shown as categorical variables with frequencies (percentages).
hospital stays of
