5 Reasons Hospitals Must Deputize Patients to Reduce Infections

By Ramzy Nasrallah | March 22, 2017

TRIVIA: How long has the world known that hand-washing is the single-most effective and simple means for reducing the transmission of illnesses, germs and infections?

We’ll get to the answer shortly. You have known it’s something you’re supposed to do since you were a child, but it goes beyond childhood.

The CDC introduced its Clean Hands Count campaign for doctors and nurses in 2016 to urge clinicians to comply with hand-washing protocol. Let’s repeat that, for emphasis: We still need to remind doctors and nurses to wash their hands. In 2016.

They still need help now. They will need help tomorrow too.

Ignoring the clue

Germ Theory – which suggested microorganisms were responsible for spreading diseases – was first proposed almost half a millennium ago. But Germ Theory didn’t clue us into the value of hand hygiene in preventing the spread of disease.

The clue appeared in 1847, a mere 171 years ago during an investigation into why patients in the doctors’ wards at an obstetrical clinic were contracting and dying from postpartum infections three times more often than the patients in the midwives’ wards.

It was later determined the doctors’ hands were the culprit. Doctors were conducting autopsies and then heading straight into labor and delivery without washing. Midwives were not conducting autopsies; hence the disparity in infection rates.

The intervention – hand hygiene – nearly eliminated mortality in the unit.

His intervention – hand hygiene – nearly eliminated mortality in the unit. But back to that trivia question – as you just read, the answer is 171 years. And 171 years later, hand-washing compliance remains dismal, while the CDC is investing in assets to help very intelligent doctors and nurses comply with something we tell children they need to do.1

More signage and louder noises aren’t going to finally push clinicians toward unwavering hand-washing compliance after 171 years of failing.

Why are we so bad at this?

1. Denial. Nobody thinks they are germy. It’s everyone else.
2. Mundane. Done properly, clinicians would wash their hands dozens of times every shift.
3. Skin Irritation to antiseptics and repeated cleaning.
4. Alarm fatigue. Eventually, all the signs and beeps and pleas become ambient hospital noise.
5. We hate being told what to do. Nobody likes a taskmaster, and besides – no one thinks they’re the problem.
Our issues with hand-washing aren’t epidemiological. They’re almost purely psychological.

Studies show clinicians wash their hands more when cameras are present, but even then there can be camera fatigue when it starts to feel like another piece of furniture in the room.

A new approach

Let’s work with the patients who generally prefer to remain infection-free while hospitalized.

The Association for Vascular Access has developed a program for hospitals to empower and deputize patients to watch for abnormalities based entirely on existing hospital policies and protocol. It is as primitive as it is powerful, helping patients understand what they should expect and what normal looks like.

A very small sampling of our Patient Advocacy Program (it literally begins and ends with hand hygiene):

  • Anyone who enters your room must wash their hands before proceeding.
  • If you’re getting an IV, getting poked a bunch of times is not normal and shouldn’t happen.
  • If you’re getting an IV, that procedure is not supposed to be extremely painful.
  • Anyone who leaves your room must wash their hands when they exit.

This is not about being perfect. Anyone can find holes in a plan and makes excuses for inaction if they look hard enough (But patients sleep! In my unit they’re intubated! Sometimes they don’t speak English!)

This is about putting patients in position to help hospitals achieve the irreducible minimum of complications. This is about increasing and maintaining a high level of hand hygiene compliance and a culture of vigilance, that’s aided by a deputized patient.

This is about extracting the fatigue from a cause that cannot afford complacency, because germs never get bored.

So how long has the world known that hand-washing is the single-most effective and simple means for reducing the transmission of illnesses, germs and infections? Long enough.

We can succeed where generations have failed by getting all hands on deck. Not just yours.

You can get the latest trends from vascular access and learn more about reducing the spread of infection.


1. Using High-Technology to Enforce Low-Technology Safety Measures: The Use of Third-party Remote Video Auditing and Real-time Feedback in Healthcare. Clinical Infectious Diseases. 21 November 2011.

Categories: Expert Views, Infection Prevention, Patient Experience

Ramzy Nasrallah

Chief Executive Officer, AVA

Ramzy Nasrallah joined the Association for Vascular Access (AVA) in 2017 as chief executive officer. Prior to joining AVA, he spent 14 years at Johnson & Johnson in both its pharmaceutical and medical device businesses. Nasrallah has extensive experience and understanding of the critical issues and opportunities surrounding vascular access and healthcare delivery in America and abroad. Nasrallah leads the mission and strategic plan for both AVA as well as the AVA Foundation.

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