Educating parents on ‘Speaking up for hand hygiene’ in PICU: Perceptions and barriers
Keywords:intensive care, mechanical ventilation, pa(e)diatric, parents, Speaking up for hand hygiene'
Background: Hand hygiene is fundamental approach to prevent and control spread of infection. Many measures available to enhance compliance to hand hygiene, yet little is known of ‘speaking up for hand hygiene’ initiative among parents and nurses especially in paediatric intensive care unit (PICU). Aim: To assess parents’ and nurses’ perceptions on ‘speaking up for hand hygiene’ in the prevention of ventilator-associated pneumonia (VAP) in a PICU. Methods: We revised evidence-based information related to VAP preventative strategies for a PICU population and updated education materials for staff and families using the ‘Speaking up for Hand Hygiene’ initiative. Parents of children receiving mechanical ventilation were provided with education on hand hygiene. Parents and staff groups were invited to participate in a survey exploring their confidence with this initiative. Results: Parents (78.9%) and nurses (91.2%) agreed the initiative would increase hand hygiene practice. Parents (94.5%) would welcome being reminded about hand hygiene but only 68.4% of parents were willing to remind nurses and 78.9% to remind other PICU staff. Nurses (88.2%) reported being willing to remind parents and other PICU staff and 88.2% indicated that they would welcome being reminded about hand hygiene from parents and 94.1% from other PICU staff. Conclusion: Parents of children receiving mechanical ventilation and PICU nursing staff perceived ‘Speaking up for hand hygiene’ as an important initiative. There are, however factors that contribute to a reluctance to prompt hand hygiene that require further research.
Daniels JP, Hunc K, Cochrane DD, Carr R, Shaw NT, Taylor A, Heathcote S, Brant R, Lim J, Ansermino JM. Identification by families of pediatric adverse events and near misses overlooked by health care providers. CMAJ. 2012 Jan 10;184(1):29-34.
World Health Organization. WHO guidelines on hand hygiene in health care. In WHO guidelines on hand hygiene in health care 2009 (pp. 270-270).
Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC health services research. 2014 Dec;14(1):1-8.
Bsharat S, Drach?Zahavy A. Nurses’ response to parents’‘speaking?up’efforts to ensure their hospitalized child's safety: an attribution theory perspective. Journal of advanced nursing. 2017 Sep;73(9):2118-28.
The Joint Commission. Speak up: Prevent the spread of infection. 2018. Available at: https://www.jointcommission.org/multimedia/speak-up--prevent-the-spread-of-infection/
Bellissimo-Rodrigues F, Pires D, Zingg W, Pittet D. Role of parents in the promotion of hand hygiene in the paediatric setting: a systematic literature review. Journal of Hospital Infection. 2016 Jun 1;93(2):159-63.
Eichner JM, Johnson BH. Committee on Hospital Care and Institute for Patient-and Family Centered Care. Patient-and family-centered care and the pediatrician’s role. Pediatrics. 2012;129(2):394-404.
Australian Commission on safety and Quality in Health Care. National Hand Hygiene Initiative. 2013. Available at: https://www.safetyandquality.gov.au/
Chang E, Easterbrook S, Hancock K, Johnson A, Davidson P. Evaluation of an information booklet for caregivers of people with dementia: an Australian perspective. Nursing & health sciences. 2010 Mar;12(1):45-51.
Kim MK, Nam EY, Na SH, Shin MJ, Lee HS, Kim NH, Kim CJ, Song KH, Choe PG, Park WB, Bang JH. Discrepancy in perceptions regarding patient participation in hand hygiene between patients and health care workers. American journal of infection control. 2015 May 1;43(5):510-5.
Samuel R, Shuen A, Dendle C, Kotsanas D, Scott C, Stuart RL. Hierarchy and hand hygiene: would medical students speak up to prevent hospital-acquired infection? Infection Control & Hospital Epidemiology. 2012 Aug;33(8):861-3.
World Health Organization. Clean care is safer care: Tools for evaluation and feedback.
Wu KS, Lee SS, Chen JK, Tsai HC, Li CH, Chao HL, Chou HC, Chen YJ, Ke CM, Huang YH, Sy CL. Hand hygiene among patients: attitudes, perceptions, and willingness to participate. American journal of infection control. 2013 Apr 1;41(4):327-31.
IBM. SPSS Statistics for Window (Version 24.0). 2016. New York: IBM Corp
Buser GL, Fisher BT, Shea JA, Coffin SE. Parent willingness to remind health care workers to perform hand hygiene. American journal of infection control. 2013 Jun 1;41(6):492-6.
Albert BD, Petti C, Caraglia A, Geller M, Horak R, Barrett M, Hastings R, O’Brien M, Ormsby J, Sandora TJ, Kleinman ME. Multidisciplinary quality improvement intervention to achieve sustained improvement in hand hygiene reliability in a pediatric intensive care unit. Pediatric quality & safety. 2019 Nov;4(6).
Chandonnet CJ, Boutwell KM, Spigel N, Carter J, DeGrazia M, Ozonoff A, Flaherty K. It's in your hands: An educational initiative to improve parent/family hand hygiene compliance. Dimensions of Critical Care Nursing. 2017 Nov 1;36(6):327-33.
Davis R, Parand A, Pinto A, Buetow S. Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene. Journal of Hospital Infection. 2015 Mar 1;89(3):141-62.
Degli Atti ML, Tozzi AE, Ciliento G, Pomponi M, Rinaldi S, Raponi M. Healthcare workers' and parents' perceptions of measures for improving adherence to hand-hygiene. BMC Public Health. 2011 Dec;11(1):1-8.
Uhl T, Fisher K, Docherty SL, Brandon DH. Insights into patient and family?centered care through the hospital experiences of parents. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2013 Jan 1;42(1):121-31.
Azab SF, Sherbiny HS, Saleh SH, Elsaeed WF, Elshafiey MM, Siam AG, Arafa MA, Alghobashy AA, Bendary EA, Basset MA, Ismail SM. Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP prevention Bundle”: a cohort study. BMC infectious diseases. 2015 Dec;15(1):1-7.
Obeid A, Naous A, Naja Z, Naja AS, Abou Merhi B, Rajab M. Preventing ventilator associated pneumonia (VAP) in a pediatric intensive care unit using a modified ventilator associated pneumonia bundle: Pre-interventional and post-interventional trial. Res J Med Sci. 2014;8(1):13-9.
Meert KL, Clark J, Eggly S. Family-centered care in the pediatric intensive care unit. Pediatric Clinics. 2013 Jun 1;60(3):761-72.
Corlett J, Twycross A. Negotiation of parental roles within family?centred care: a review of the research. Journal of clinical nursing. 2006 Oct;15(10):1308-16.
Pan SC, Tien KL, Hung IC, Lin YJ, Yang YL, Yang MC, Wang MJ, Chang SC, Chen YC. Patient empowerment in a hand hygiene program: differing points of view between patients/family members and health care workers in Asian culture. American journal of infection control. 2013 Nov 1;41(11):979-83.
Coyne I, Murphy M, Costello T, O’Neill C, Donnellan C. A survey of nurses’ practices and perceptions of family-centered care in Ireland. Journal of family nursing. 2013 Nov;19(4):469-88.
Smith J, Swallow V, Coyne I. Involving parents in managing their child's long-term condition—a concept synthesis of family-centered care and partnership-in-care. Journal of pediatric nursing. 2015 Jan 1;30(1):143-59.
McGuckin M, Storr J, Longtin Y, Allegranzi B, Pittet D. Patient empowerment and multimodal hand hygiene promotion: a win-win strategy. American Journal of Medical Quality. 2011 Jan;26(1):10-7.
Noor Azizah, M.A An epidemiological study of ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE) surveillance and preventative strategies in critically ill children. Online thesis
Gautam A, Ganu SS, Tegg OJ, Andresen DN, Wilkins BH, Schell DN. Ventilator-associated pneumonia in a tertiary paediatric intensive care unit: a 1-year prospective observational study. Critical Care and Resuscitation. 2012 Dec;14(4):283-9.
Dixit D, Hagtvedt R, Reay T, Ballermann M, Forgie S. Attitudes and beliefs about hand hygiene among paediatric residents: a qualitative study. BMJ open. 2012 Jan 1;2(6):e002188.
Longtin Y, Sax H, Allegranzi B, Hugonnet S, Pittet D. Patients' beliefs and perceptions of their participation to increase healthcare worker compliance with hand hygiene. Infection Control & Hospital Epidemiology. 2009 Sep;30(9):830-9.
Boscart VM, Fernie GR, Lee JH, Jaglal SB. Using psychological theory to inform methods to optimize the implementation of a hand hygiene intervention. Implementation Science. 2012 Dec;7(1):1-2.
Fitzpatrick M, Everett?Thomas R, Nevo I, Shekhter I, Rosen LF, Scheinman SR, Arheart KL, Birnbach DJ. A novel educational programme to improve knowledge regarding health care?associated infection and hand hygiene. International Journal of Nursing Practice. 2011 Jun;17(3):269-74.
Koff MD, Corwin HL, Beach ML, Surgenor SD, Loftus RW. Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program. Journal of critical care. 2011 Oct 1;26(5):489-95.
Koff MD, Loftus RW, Burchman CC, Schwartzman JD, Read ME, Henry ES, Beach ML. Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device. The Journal of the American Society of Anesthesiologists. 2009 May 1;110(5):978-85.
Boscart VM, McGilton KS, Levchenko A, Hufton G, Holliday P, Fernie GR. Acceptability of a wearable hand hygiene device with monitoring capabilities. Journal of Hospital Infection. 2008 Nov 1;70(3):216-22.
Levchenko AI, Hufton GC, Boscart VM, Fernie GR. Embedded system for hygiene compliance monitoring. IEEE Transactions on Automation Science and Engineering. 2010 Mar 29;7(3):695-8.
Talbot TR, Johnson JG, Fergus C, Domenico JH, Schaffner W, Daniels TL, Wilson G, Slayton J, Feistritzer N, Hickson GB. Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives. Infection Control & Hospital Epidemiology. 2013 Nov;34(11):1129-36.