Exploring Patient Engagement in HAI-Prevention Programs

On Wednesday March 29, 2017, at the Society for Healthcare Epidemiology of America (SHEA) Spring 2017 Conference, Heather Schacht Reisinger, PhD, MAA, medical anthropologist, associate director for Research and Core Investigation for the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the US Department of Veterans Affairs, and associate professor in the General Internal Medicine Division at University of Iowa Carver College of Medicine, discussed the importance of the patient in preventing healthcare-associated infections (HAIs).

According to Dr. Reisinger, “Patient engagement, obviously, is part of this much broader trend. It’s been linked with health literacy for patients; …trying to increase shared decision-making between providers and their patients; [and] trying to increase self-care and self-management of health conditions, particularly chronic conditions,” among other things.

Through her past work, Dr. Reisinger has found that patient engagement and activation have proven to be successful forms of intervention in healthcare. Not only have these methods helped patients with substance abuse addictions recover, they have also helped patients with hypertension switch to thiazide treatment. However, Dr. Reisinger herself has not participated in any research regarding patient engagement to prevent HAIs.

Dr. Reisinger started her discussion with a definition of patient engagement, which she quoted from a 2011 book written by Angela Coulter, PhD, entitled Engaging Patients in Healthcare: “To promote and support active patient public involvement in health and healthcare and to strengthen their influence on healthcare decisions, at both the individual and collective levels.” Dr. Reisinger referenced this specific definition because it highlights the patient’s healthcare needs; after all, the patient is the one receiving the care.

The priorities of the patient, according to Dr. Reisinger, include “access to timely, reliable, effective, and safe healthcare when needed, [which is] very directly related to infection control and prevention.” Patients also need “adequate information and support to participate in decisions that affect them,” as well as “empathy, dignity, and respect” from their healthcare providers. Patients also value the chance to have treatment and healthcare management options to choose from.

Along with the definition of patient engagement, Dr. Coulter’s book also provides its reader with a conceptual framework for patient engagement. According to the framework, there are three levels of engagement: direct patient care, at the individual level; organizational design and governance, such as hospitals and healthcare systems; and policy making, at the collective level. Engagement on these levels needs to be continuous, which can be accomplished through consultations, direct involvement of the healthcare provider, and finally, through partnership and shared leadership between the patient and his or her family and the healthcare provider. This framework provides a great example of what patient engagement looks like, said Dr. Reisinger.

“As far as effectiveness, engaged patients report higher quality and fewer errors, have reduced healthcare utilization and costs, and have a positive impact on health outcomes, [such as] increased medication adherence, reduced rates of hospital admissions and reduced lengths of stay, [and] increased preventative care,” she said.

With regards to effectiveness of patient engagement to reduce or prevent HAIs, hand hygiene is one of the more critical practices where patients are becoming increasingly active. Patients are asked to monitor hand hygiene (HH) among their healthcare providers. Dr. Reisinger gave the example of HH cards where patients go in for their primary care appointments, and after which they fill out the cards, marking whether or not their healthcare providers practiced proper HH, and hand them in through designated boxes, which add a bit of anonymity to the process. Other methods include patients directly asking providers to wash their hands. In addition, patients are also educated on HH and practice it themselves so that they are engaged in the patient safety process and can, therefore, reduce transmission.

In her presentation, Dr. Reisinger cited an article that was published in a 2012 issue of the American Journal of Infection Control. “What I really liked about this article,” she said, “is that it includes how patient engagement has been integrated into policy, [such as with] The Joint Commission’s ‘Speak Up’ Program, [the World Health Organization’s] ‘Save Lives: Clean Your Hands’ Campaign, the UK’s ‘Cleanyourhands’ Campaign, and Canada’s ‘Stop! Clean Your Hands’ Campaign.” Most of these campaigns focus on educating the patient to ask healthcare workers to wash their hands, and exemplify the different levels through which healthcare workers can engage patients.

A more recent study published in a 2016 issue of the Lancet, used a single-center cluster randomized control trial to study standard multimodal promotion and enhanced performance feedback­­. Standard multimodel promotion involves “immediate feedback to healthcare workers after observation period, and quarterly reports including hospital-wide rates of HH with a target goal of 80% compliance,” compared with enhanced performance feedback with patient participation. Enhanced performance feedback involves “the enhanced approach and welcome packet for patients, including a brochure with HH indications for patients and hand sanitizer; educating patients on importance of ‘reminding’ healthcare workers to sanitize hands before touching patients.”

According to the study's findings, "Between the baseline period (April 1, 2009, to June 30, 2010) and the intervention period (July 1, 2010, to June 30, 2012), mean hand hygiene compliance increased from 66% to 73% in the control group; from 65% to 75% in the enhanced group; and from 66% to 77% in the enhanced performance feedback plus patient participation group. Absolute difference in compliance attributable to the interventions was 3 percentage points (95% CI 0-7; P=.19) for enhanced and 4 percentage points (1-8; P=.048) for enhanced + patient participation.”

These results show that intervention had an impact on improving HH rates, said Dr. Reisinger. However, the researchers were not able to reach their goal of 80% compliance.

Overall, patient engagement is proving to be an effective approach aiding in the prevention of HAIs. There are several different avenues that healthcare providers can take to involve patients in HAI prevention, and the practice of proper hand hygiene seems to be a recurring approach among several speakers at the SHEA Spring 2017 conference.

DISCLOSURES

The opinions expressed in the presentation are those of the author and do not necessarily reflect the views of the Department of Veterans Affairs.

SOURCE

SHEA Spring 2017 Conference

PRESENTATION

Engaging Patients in Activities to Prevent HAIs