Major Article| Volume 48, ISSUE 1, P61-67, January 2020

Discourse on hygiene between hospitalized patients and health care workers as an accepted norm: Making it legitimate to remind health care workers about hand hygiene


      • Use video clips to grant legitimacy to reminding health care workers about hand hygiene.
      • Specify barriers and solutions that hospitalized patients and health care workers can identify with.
      • Turn discourse on hand hygiene into an accepted norm and a joint responsibility.



      Despite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs.


      Intervention type 2 design and examination of 2 population groups—HPs and HCWs—before and after intervention by means of mixed methods research.


      Both HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation.


      To overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.

      Key Words

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        • Erasmus V
        • Daha TJ
        • Brug H
        • Richardus JH
        • Behrendt MD
        • Vos MC
        • et al.
        Systematic review of studies on compliance with hand hygiene guidelines in hospital care.
        Infect Control Hosp Epidemiol. 2010; 31: 283-294
        • WHO
        Report on the burden of endemic health care-associated infection worldwide.
        World Health Organization, Geneva, Switzerland2011
        • Huis A
        • van Achterberg T
        • de Bruin M
        • Grol R
        • Schoonhoven L
        • Hulscher M
        A systematic review of hand hygiene improvement strategies: a behavioural approach.
        Implement Sci. 2012; 7: 92
        • Zingg W
        • Holmes A
        • Dettenkofer M
        • Goetting T
        • Secci F
        • Clack L
        • et al.
        Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus.
        Lancet Infect Dis. 2015; 15: 212-224
        • State Comptroller
        Annual Control Report 63c for 2012 and for accounting for financial year 2011.
        The State Comptroller and Ombudsman of Israel, Jerusalem2013
        • Pincock T
        • Bernstein P
        • Warthman S
        • Holst E
        Bundling hand hygiene interventions and measurement to decrease health care-associated infections.
        Am J Infect Control. 2012; 40: S18-S27
        • Seale H
        • Chughtai AA
        • Kaur R
        • Phillipson L
        • Novytska Y
        • Travaglia J
        Empowering patients in the hospital as a new approach to reducing the burden of health care-associated infections: the attitudes of hospital health care workers.
        Am J Infect Control. 2016; 44: 263-268
        • Allegranzi B
        • Pittet D
        Role of hand hygiene in healthcare-associated infection prevention.
        J Hosp Infect. 2009; 73: 305-315
        • Nicol PW
        • Watkins RE
        • Donovan RJ
        • Wynaden D
        • Cadwallader H
        The power of vivid experience in hand hygiene compliance.
        J Hosp Infect. 2009; 72: 36-42
        • Pittet D
        • Allegranzi B
        • Sax H
        • Dharan S
        • Pessoa-Silva CL
        • Donaldson L
        • et al.
        Evidence-based model for hand transmission during patient care and the role of improved practices.
        Lancet Infect Dis. 2006; 6: 641-652
        • Yokoe DS
        • Anderson DJ
        • Berenholtz SM
        • Calfee DP
        • Dubberke ER
        • Ellingson KD
        • et al.
        A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 Updates.
        Am J Infect Control. 2014; 42: 820-828
        • 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.
        J Hosp Infect. 2015; 89: 141-162
        • McGuckin M
        • Govednik J
        Patient empowerment and hand hygiene, 1997-2012.
        J Hosp Infect. 2013; 84: 191-199
        • Alzyood M
        • Jackson D
        • Brooke J
        • Aveyard H
        An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting.
        J Clin Nurs. 2018; 27: 1329-1345
        • Stewardson AJ
        • Sax H
        • Gayet-Ageron A
        • Touveneau S
        • Longtin Y
        • Zingg W
        • et al.
        Enhanced performance feedback and patient participation to improve hand hygiene compliance of health-care workers in the setting of established multimodal promotion: a single-centre, cluster randomised controlled trial.
        Lancet Infect Dis. 2016; 16: 1345-1355
        • Seale H
        • Travaglia J
        • Chughtai AA
        • Phillipson L
        • Novytska Y
        • Kaur R
        ‘I don't want to cause any trouble’: the attitudes of hospital patients towards patient empowerment strategies to reduce healthcare-acquired infections.
        J Infect Prevent. 2015; 16: 167-173
        • Pan SC
        • Sheng WH
        • Tien KL
        • Chien KT
        • Chen YC
        • Chang SC
        Promoting a hand hygiene program using social media: an observational study.
        JMIR Public Health Surveill. 2016; 2: e5
        • Creswell JW
        • Hanson WE
        • Plano VLC
        • Morales A
        Qualitative research designs: selection and implementation.
        Couns Psychol. 2007; 35: 235-264
        • Johnson RB
        • Onwuegbuzie AJ
        Mixed methods research: a research paradigm whose time has come.
        Educ Res. 2004; 33: 14-26
        • Gesser-Edelsburg A
        • Zemach M
        • Cohen R
        • Salmon A
        • Lowenstein L
        • Shteinberg D
        What variables are associated with the public's willingness to take measures to maintain a hygienic hospital environment?.
        Am J Infect Control. 2018; 46: 1245-1253
        • Tolley EE
        • Ulin PR
        • Mack N
        • Robinson ET
        • Succop SM
        Qualitative methods in public health: a field guide for applied research.
        2nd ed. Jossey-Bass, San Francisco (CA)2016
        • Wimpenny P
        • Gass J
        Interviewing in phenomenology and grounded theory: is there a difference?.
        J Adv Nurs. 2000; 31: 1485-1492
        • Plano Clark VL
        • Huddleston-Casas CA
        • Churchill SL
        • O'Neil Green D
        • Garrett AL
        Mixed methods approaches in family science research.
        J Family Issues. 2008; 29: 1543-1566
        • Rose S
        • Spinks N
        • Canhoto AI
        Management research: applying the principles.
        Routledge, New York (NY)2015
        • Flick U
        The SAGE handbook of qualitative data analysis.
        Sage, London2014
        • Hsieh H-F
        • Shannon SE
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • Nacioglu A
        As a critical behavior to improve quality and patient safety in health care: speaking up!.
        Saf Health. 2016; 2: 10
        • Ridley J
        • Jones L
        User and public involvement in health services: a literature review.
        NHS Scotland, Edinburgh, Scotland2002
        • Garcia-Williams A
        • Brinsley-Rainisch K
        • Schillie S
        • Sinkowitz-Cochran R
        To ask or not to ask?: The results of a formative assessment of a video empowering patients to ask their health care providers to perform hand hygiene.
        J Patient Saf. 2010; 6: 80-85
        • Lastinger A
        • Gomez K
        • Manegold E
        • Khakoo R
        Use of a patient empowerment tool for hand hygiene.
        Am J Infect Control. 2017; 45: 824-829