Healthcare-Associated Infections _ ______________________________________________________________
• Consensus, leadership, and role models (social influence model) • Quality improvement teams, process redesign, and fostering of a safety-oriented culture (organizational model) Healthcare facilities should explore innovative ways to develop quality improvement initiatives. In an effort to enhance adher- ence to the CDC guidelines on hand hygiene, a group of three hospitals used the Six Sigma approach with success. Six Sigma is a process established in the business world to achieve and sustain excellence in general operations and service [325]. One healthcare facility used the process to organize the knowledge, opinions, and actions of physicians, nurses, and other staff in four ICUs at the facilities, resulting in an increase in compli- ance from 47% to 80% [326]. Given the suboptimal rates of influenza vaccination among healthcare workers, education on the importance of this mea- sure is also needed. Two literature reviews have shown high rates of misconceptions or lack of knowledge about influenza, the role of healthcare professionals in transmitting influenza to patients, and the importance and risks of vaccination [327; 328]. Education on vaccination should be targeted to address these attitudes and beliefs. In addition, some studies have indicated that self-protection is a primary reason healthcare professionals decide to be vaccinated, and education that focuses on this aspect may help improve vaccination rates [328].
Physicians and other healthcare professionals should educate patients and families about ways to prevent infection, especially with regard to their specific factors (e.g., surgery, insertion of a urinary catheter). Clinicians should also explain the impor- tance of the appropriate use of antibiotics, including the need to complete the recommended antibiotic treatment course; the relationship between the inappropriate use of antibiotics and the increasing prevalence of drug-resistant bacteria; and the implications of drug-resistant bacteria. Patients should be encouraged to help promote adequate hand hygiene by asking their healthcare providers if they have washed their hands. The CDC has developed a library of “Clean Hands Count” materials for patients and healthcare workers, which is avail- able on its website (https://www.cdc.gov/clean-hands/hcp/ clean-hands-coun). The ability to understand health information and make informed health decisions, known as health literacy, is integral to good health outcomes [329]. Yet, the National Assessment of Adult Literacy estimated that only 12% of adults have “proficient” health literacy and 14% have “below basic” health literacy [330]. Rates of health literacy are especially low among ethnic minority populations and individuals older than 60 years of age [329]. Compounding the issue of health literacy is the high rate of individuals with limited English proficiency. According to the U.S. Census Bureau data from 2023, more than 71.1 million Americans speak a language other than Eng- lish in the home, with more than 27.6 million of them (5.6% of the population) speaking English less than “very well” [331]. Clinicians should assess their patients’ literacy level and understanding and implement interventions as appropriate. Healthcare professionals should use plain language in their discussions with patients who have low literacy or limited English proficiency. They should ask them to repeat pertinent information in their own words to confirm understanding. Reinforcement with the use of low-literacy or translated edu- cational materials may be helpful. Translation services should be provided for patients who do not understand the clinician’s language. “Ad hoc” interpreters (family members, friends, bilingual staff members) are often used instead of professional interpreters for a variety of reasons, including convenience and cost. However, clinicians should check with their state’s health officials about the use of ad hoc interpreters, as several states have laws about who can interpret medical information for a patient [332]. Children should especially be avoided as interpreters, as their understanding of medical language is limited and they may filter information to protect their parents or other adult family members [332]. Individuals with limited English language skills have actually indicated a preference for professional interpreters rather than family members [333]. Most important, perhaps, is the fact that clinical consequences are more likely with ad hoc interpreters than with professional interpreters [334; 335; 336].
EDUCATION FOR PATIENTS AND FAMILIES
Education for patients and families is an important component of an overall prevention strategy, and the U.S. Department of Health and Human Services notes that such education is a critical part of the national effort on preventing HAIs [2]. Many national-level initiatives have been launched to encour- age individuals to become more active in their health care and to be their own advocates, and patients, family members, and hospital visitors should be encouraged to become partners in preventing the transmission of infection in the healthcare setting [25]. Hospitals should engage patients in their own care by discuss- ing infection control measures for hand hygiene practices, respiratory hygiene practices, and contact precautions (accord- ing to the patient’s condition) with the patient and his or her family members on the day the patient enters the hospital or as soon as possible thereafter. For patients who are to have surgery, healthcare professionals should describe the measures that will be taken to prevent adverse events. This informa- tion may be provided in any form of media, and the patient’s understanding of the information should be evaluated and documented.
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