perspectives
By Maryanne McGuckin, Dr. ScEd., FSHEA
Hands-On Learning:
What Has the COVID-19
Pandemic Taught Us
About Hand Hygiene and
Empowerment?
W
hen the original projected estimates of 100,000 to
200,000 deaths from COVID 19 were made public,
there was immediate awareness, concern, engagement and
a demand for information by consumers. People around the
world were instantly and acutely aware of their own health and
the health of their loved ones. Interestingly the World Health
Organization (WHO) definition of empowerment has as its
foundation, knowledge, awareness and engagement. 1 Press
conferences, scientific updates and social media informed
us not only of the number of cases but the importance of
hygiene etiquette and hand hygiene (HH) to control the spread.
Social media has educated and empowered Americans
about HH in an unprecedented way during the pandemic.
Take, for instance, the response our country has given to what
is often referred to as the silent epidemic – healthcare-asso-
ciated infections (HAIs). One in 31 hospital patients has at
least one HAI resulting in an estimated 687,000 HAIs and
approximately 72,000 deaths yearly. 2 We know that proper
HH is an effective method of reducing HAIs and yet, the
education and empowerment of Americans to combat this
epidemic falls short in comparison to our COVID-19 response.
I could not help but think of my early career, with efforts
to make HH a measurable part of infection control programs.
We have also made progress on some HAIs as the result of
mandatory reporting at the state and federal level, as well as
consumer groups. All of these have made consumers aware
of the risk of HAIs but our research has shown that only 38
percent of consumers use the data. 3 They are aware of the
risk, but are slow to engage. In fact, we recently conducted
a consumer awareness survey similar to one conducted 30
years ago at the University of Virginia. 4 We found awareness
of the risk of HAIs has changed very little in three decades
(62 percent in 1989 vs. 65 percent in 2019). However, we
found in 1983 that 83 percent of consumers believed HAIs
are preventable, whereas in 2019 it was only 28 percent. 5
Consumers see HAIs as a risk of healthcare and likely the
reason awareness does not lead to engagement in terms
of being empowered to ask about HH. We know that
engagement is directly related to having an HAI personally.
For the last decade, work has focused on the role of
the patient (i.e. patient empowerment) in HH compliance,
including the WHO Global Challenge for HH. 1 For the first time,
empowerment of patients and healthcare workers (HCWs,
was made part of a multi-modal program and referred to as
“win-win strategy.” 6 Measurement was seen as an important
8
component of HH programs. We can say that by having a
multi-modal program, compliance has improved and that
many facilities have reached 70 percent compliance.
Given the research and historically slow rate of improve-
ment in compliance, why have we seen rapid adoption of HH
practices during the COVID-19 crisis? I believe it comes down
to fear, knowledge and constant reminders, Consumers see an
immediate call to action and their individual role in respsnse
to the public health emergency. Post-COVID-19 patients are
now fearful of hospitals and healthcare providers, so this is
our opportunity to be truthful and provide patients with
knowledge about the importance of HH and empower them
to be a constant reminder to their HCWs. There will be no
better time then now to follow up on the importance of HH.
During the current COVID -19 crisis, social media has been
a primary source of knowledge for consumers; however, our
research prior to COVID-19 found that only 14 percent of
consumers used social media for information, listing difficulty
in gaining access and/or understanding. Their primary source
for information was their HCW. 6
We must use the HH compliance messages we have seen
in social media as part of new and continued programs.
Remember, your patients remain the constant variable in
healthcare, and now, with personal experience of a public
health emergency, they are willing to be empowered and
engaged beyond this time of crisis. Keep your message simple
and direct, provide patients with skills they need, and deliver
messages in an accepting environment that restores trust in
our healthcare system. Let’s put our hands-on learning from
the pandemic to work and commit to an everyday call to
action around HH empowerment.
Maryanne McGuckin, Dr. ScEd., FSHEA is an internationally
renowned advocate for healthcare quality, hospital safety
and patient advocacy. Her distinguished body of work is
represented in over 100 peer-reviewed abstracts, journal
articles, and scientific conference lectureships. Her most
recent publication, The Patient Survival Guide – 8 Simple
Solutions to Prevent Hospital- and Healthcare-Associated
Infections, has received acknowledgment in healthcare
reviews and national media.
References:
1. World Health Organization. WHO Guidelines on Hand Hygiene in
Health Care. 2009.
2. CDC. 2018 National and State Healthcare-Associated Infections Progress
Report. Nov. 1, 2019. https://www.cdc.gov/hai/data/portal/progress-report.html
3. McGuckin M, Govednik J, Hyman, D, Black, B. Public Reporting have
Healthcare-Associated Infection Rates: Are Consumers Aware and Engaged?
Am J Med Qual. Vol. 29, No. 1, 81-85. 2014,
4. Miller PJ, Farr BM. Survey of patients’ knowledge of nosocomial
infections. Am J Infect Control. 17(1): 31-4. Feb. 1989.
5. McGuckin M, Storr J, Govednik J. Patient Awareness of Healthcare-
Associated Infection Risk and Prevention: Has There Been a Change in Three
Decades (1989-2019)? Submitted April 2020 to Infect Control Hosp Epidemiol.
6. McGuckin M, Storr J, Longtin Y, Allegranzi B, Pittet D. Patient
empowerment and multimodal hand hygiene promotion: a win-win strategy.
Am J Med Qual. Jan-Feb;26:10-7. 2011.
may 2020 • www.healthcarehygienemagazine.com