Study: Hospital Patients Can Play Role in Preventing C. difficile Spread

Patient hand hygiene is an important preventative measure that should be considered for hospitals and their patients battling Clostridium difficile (C. difficile) infections, according to a new report.

Researchers from the UPMC Mercy Hospital in Pittsburgh conducted a 2-phase “quasi-experiemental” study in order to increase patient hand hygiene throughout the 495-bed university-affiliated medical center in a large health care system, between November 2013 and December 2015.

The study was designed in response to increasing hospital C. difficile infections by infection prevention specialists and nursing leadership. Another factor that contributed to the need for this study was assessments of patient hand hygiene on patient units that indicated patients were not being offered opportunities to clean their hands properly.

In the first phase, baseline surveys were conducted to assess patient hand hygiene on 4 medical surgical nursing units. Each of the units had an average daily census of about 35 patients. Staffs from each of the units were shown an educational presentation by nurse educators on the topic of hand hygiene and how it can effectively prevent infection. The staffs learned to give verbal instructions on patient hand hygiene — as well as reminders, assistance, and encouragement – to newly admitted patients, including soap and water hand washing alongside bedside alcohol hand wipes.

This process took place again through the entire hospital for the second phase, beginning in March 2015. Previous prevention methods included early stool testing, contact precautions during stool testing, environmental cleaning with hydrogen peroxide, ultraviolet disinfection in isolation rooms, hand hygiene for all staff when caring for a C. difficile infected patient, and an active antibiotic stewardship program. Nothing was changed once phase 2 of the study kicked in. Meanwhile, the infection preventionists continued to monitor C. difficile infection rates once patient hand hygiene use and encouragement was introduced.

One of the most surprising findings of the study, infection preventionist and study author Marian Pokrywka, PhD, MHP, told MD Magazine, was the number of patient that were not able to get to the sink on their own without assistance. These patients had not had or were not offered an opportunity to clean their hands that day, she said, and that was something the hospital was looking to improve.

After the first phase, hand hygiene education reached a third of the patients, while patient hand hygiene methods had reached 60% of the patients. In phase 2, education on hand hygiene and patient hand hygiene increased to 64% and 86%, respectively. The frequency of patient hand hygiene reported by patients increased from 2.7 to 3.75 times, while 99% of patients rated hand hygiene highly on a scale regarding the importance of infection prevention.

Patient hand hygiene opportunities for cleaning hands increased after each of the following occasions: prior to meals, after using the toilet, before touching dressings and incisions, after coming back from testing, and after having visitors.

“We use a multifaceted approach called ‘bundles’ where we hit an organisms or disease with several different things to protect patients from acquisition,” Pokrywka said. “The traditional C. difficle bundles include healthcare worker hand hygiene with soap and water, environmental cleaning, and early isolation of the patient along with rapid testing for C. difficile in any patient with suspected disease.”

Eventually, she said, she would like to see patient hand hygiene added to hospitals’ bundles all over the country, as it can be “one more thing in our arsenal to attack this infection.”

“It has recently been suggested in a family practice journal that every patient encounter with a health care provider, including physicians, should start with hand hygiene for both the patient and the provider,” Pokrywka said. “This is what we would like to see happen in the future of healthcare!”

The study, “Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center?,” was published in the American Journal of Infection Control.