Patients’ feelings about hand washing, MRSA status and patient information

Defining the user role in infection control

BACKGROUND

Health policy initiatives continue to recognize the valuable role of patients and the public in improving safety, advocating the availability of information as well as involvement at the point of care. In infection control, there is a limited understanding of how users interpret the plethora of publicly available information about hospital performance, and little evidence to support strategies that include reminding healthcare staff to adhere to hand hygiene practices.

AIM

To understand how users define their own role in patient safety, specifically in infection control.

METHODS

Through group interviews, self-completed questionnaires and scenario evaluation, user views of 41 participants (15 carers and 26 patients with recent experience of inpatient hospital care in London, UK) were collected and analysed. In addition, the project's patient representative performed direct observation of the research event to offer inter-rater reliability of the qualitative analysis.

FINDINGS

Users considered evidence of systemic safety-related failings when presented with hospital choices, and did not discount hospitals with high ('red' flagged) rates of meticillin-resistant Staphylococcus aureus. Further, users considered staff satisfaction within the workplace over and above user satisfaction. Those most dissatisfied with the care they received were unlikely to ask staff, 'Have you washed your hands?'

CONCLUSION

This in-depth qualitative analysis of views from a relatively informed user sample shows 'what matters', and provides new avenues for improvement initiatives. It is encouraging that users appear to take a holistic view of indicators. There is a need for strategies to improve dimensions of staff satisfaction, along with understanding the implications of patient satisfaction.

Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene

BACKGROUND

Patients could help to improve the hand hygiene (HH) compliance of healthcare professionals (HCPs) by reminding them to sanitize their hands.

AIM

To review the effectiveness of strategies aimed at increasing patient involvement in reminding HCPs about their HH.

METHODS

A systematic review was conducted across Medline, EMBASE and PsycINFO between 1980 and 2013.

FINDINGS

Twenty-eight out of a possible 1956 articles were included. Of these, 23 articles evaluated the effectiveness of developed patient-focused strategies and five articles examined patients' attitudes towards hypothetical strategies. Sixteen articles evaluated single-component strategies (e.g. videos) and 12 articles evaluated multi-modal approaches (e.g. combination of video and leaflet). Overall, the strategies showed promise in helping to increase patients' intentions and/or involvement in reminding HCPs about their HH. HCP encouragement appeared to be the most effective strategy. However, the methodological quality of the articles in relation to addressing the specific aims of this review was generally weak.

CONCLUSION

A number of strategies are available to encourage patients to question HCPs about their HH. Better controlled studies with more robust outcome measures will enhance understanding about which strategies may be most successful and why.

MRSA care in the community: why patient education matters

In primary care, patients are prescribed decolonisation treatment to eradicate meticillin-resistant Staphylococcus aureus (MRSA). This complex treatment process requires the patient to apply a topical antimicrobial treatment as well as adhering to rigorous cleaning regimens to ensure the environment is effectively managed. A pilot study was carried out that involved developing an enhanced, nurse-delivered education tool, training a community nurse to use it, then testing its use with a patient. Three interviews were carried out: one with a patient who received usual care, one with a patient who received the enhanced education and one with the community nurse who delivered the enhanced education tool. The patient who received the enhanced education reported better knowledge and understanding of the application of treatment than the patient who did not. These results are interesting and point the way forward for larger research studies to build on the learning from this limited exploration and develop more effective management of MRSA in primary care.

A qualitative exploration of patients' attitudes towards the 'Participate Inform Notice Know' (PINK) patient safety video

OBJECTIVE

To explore patients' attitudes towards the PINK video, a patient education video aimed at encouraging hospital patients' involvement in safety-relevant behaviours.

DESIGN

Qualitative semi-structured interviews. Detailed field notes were taken during the interviews which were analysed using content analysis.

SETTING

One National Health System (NHS) teaching hospital based in London, UK.

PARTICIPANTS

Thirty-six in-patients aged between 20 and 79 years, 18 of them males.

INTERVENTION

The PINK video is a short animated educational video aimed at encouraging patients to be involved in the safety of their care during hospitalization.

MAIN OUTCOME MEASURES

Patients' perceptions of how informative, relevant and acceptable the video is; attitudes towards participating in the recommended safety-related behaviours and; potential negative side effects of watching the video.

RESULTS

Overall the video was received favourably among the interviewees. Commonly cited benefits included raising awareness and facilitating patients to be involved in their care during their hospital stay. More variability was found in participants' views with regard to the video's role as a patient safety enhancement tool. A number of suggestions for improvement of the video were provided relating to tailoring its content and design to meet the needs of individual patients and their circumstances.

CONCLUSIONS

Educational videos such as PINK have significant potential to empower patients in the safety and quality of their care. However, efforts to implement patient safety educational videos in practice need to consider different patient groups' needs and characteristics instead of trying to adopt 'a one size fits all' approach.

Towards a better understanding of patients' perspectives of antibiotic resistance and MRSA: a qualitative study

BACKGROUND

Patients' expectations for antibiotics are known to influence prescribing, but little is known about patients' understanding of, and attitudes to, antibiotic resistance and whether these could modify treatment expectations.

OBJECTIVE

To explore primary care patients' perspectives on antibiotic resistance and methicillin-resistant Staphylococcus aureus (MRSA) and understand how these could modify expectations for antibiotics.

METHODS

A qualitative investigation using focus groups and semi-structured interviews with patients purposely sampled from low, intermediate and high antibiotic consumption groups from socio-economically contrasting general practices.

RESULTS

There was uncertainty concerning the nature and implications of antibiotic resistance for both individuals and the wider community. While some patients viewed antibiotic resistance as a problem for society, most did not see it as something that would affect them personally. Many thought that science would provide the solution through the development of new drugs. Responsibility for antibiotic resistance was mostly attributed to 'other' patients and GPs who had respectively overused and overprescribed antibiotics in the past. As MRSA was mainly seen as a hospital-based problem, blame was largely directed at hospital management and, to a lesser degree, doctors, nurses and cleaners. Concerns about antibiotic resistance were not regarded as a reason to modify individual use of antibiotics.

CONCLUSIONS

Many primary care patients are unaware of what antibiotic resistance is and how it arises. The causes of, and responsibility for, antibiotic resistance are usually attributed to external rather than personal factors and patients perceive that its solutions are outside of their control.

A survey of MRSA awareness and knowledge among the general public and patients' visitors

Our aim was to assess, for the first time, the know-ledge and perception of meticillin resistant Staphylococcus aureus (MRSA) among the general public and a group of hospital visitors.

Five hundred and forty five participants completed the survey, 24 (4.4%) had not heard of MRSA and were excluded from further analysis; 345 members of the public and 176 hospital visitors remained. Twenty four (4.4%) of the public and two of the hospital visitors had a personal history of MRSA and thus formed a discrete group. The majority of participants thought that MRSA transmission could be reduced by hand washing. MRSA evoked a strong emotive response, 61% agreeing they would be angry and 80.9% agreeing that they would feel fearful if diagnosed with MRSA.

The public are generally knowledgeable about MRSA but most agreed that they would feel angry and afraid by its diagnosis. Future public education campaigns on MRSA should be aware of this response.

New challenges and new thinking in sickle screening

Last Month saw the second annual ‘Sickle Cell Awareness Month’. As local centres and support groups reach out to their communities to improve knowledge about the disease and encourage people to get screened, there is a great deal to celebrate in the achievements of the last 12 months.