A recently published study by Tillmann Goerig, et al, of the Institute of Hygiene and Environmental Medicine, Universitätsmedizin Greifswald, Greifswald, Germany addressed the role that gender may play in infection prevention behaviors. The study, called the AHOI for, "the Activation of patients, people in need of care, and care-providers for a Hygiene-conscious participation in Infection prevention", was designed, "to clarify whether sex- and gender-specific characteristics are relevant in the field of infection prevention."
The basic concern driving this investigation was tied to the increase in the effects of hospital-acquired infections and, in particular, infections with multi-drug resistant organisms. As patients traverse from the hospital to medical offices, to home, to other community locations and back, they can be carrying these organisms with them. This can create, "an epidemiological bridge between hospitals and other care facilities", unless infection prevention materials are in place, perceived and utilized. So the point of the study was to determine whether or not there tend to be sex/gender differences in how infection prevention materials and practices are perceived, recognized, and utilized.
It may come as no surprise that women tended to be more fastidious with regard to infection prevention opportunities and practices than were the men. The study was based on surveys completed by the patients at the beginning of their hospital stay and at the end and were evenly split between men and women. The women had an average length of stay (LOS) of 5.33 days while the average LOS for the men was 7.19 days.
The results of the study are interesting in that they confirm that women are:
- • More likely to be cognizant of cleanliness and actual infection prevention opportunities than are men,
- • Less optimistic about the cleanliness and infection prevention practices of the doctors than are men, and less likely to express their misgivings to the doctors than are the men.
A basic assumption is that patient hand hygiene is as crucial as caregiver hygiene in stopping the spread of these pathogens. Therefore, many of the survey questions revolved around recognizing the presence or absence of hand sanitizer dispensers in various locations of the hospital.
The study revealed three major areas in which surveyed men and women provided significantly different answers about hospital hygiene and cleanliness.
Perception of disinfectant dispensers: In areas of the hospital such as the entrance and the cafeteria, women were statistically more likely than men to respond negatively to the question of, “Was it possible for you to disinfect your hands? – in the entrance area of the hospital"; or, "– in the cafeteria area of the hospital”.
Evaluation of cleaning processes: Women were also less likely to rate the level of hospital cleanliness and disinfection during their stay as being satisfactory.
Reception of hygiene conditions and rules: Men were more likely to believe that if they discussed the level of cleanliness of an environment to a doctor, the doctor would be receptive.
Interpreting the Results
The study could help guide an infection prevention program that drives patient compliance with hand hygiene measures. Of note was the statement that, "It is therefore to be assumed that not only the number of dispensers must be increased considerably, but they must be visually more obvious installed at spatially dominant sites. One possibility would be to position disinfectant dispensers in signal colors, centrally or “on the way,” to appeal to both men and women."
Moving Forward – With Caution
As when dealing with anything that discusses people in groups, it's worth being cautious about how much we read into the study. Cultural distinctions between patient groups, differing reasons for hospital visits and many other factors could skew survey responses. The study is also based on self-reporting and memories, which can also impact reliability.
It is important to view a study like this not as a definitive statement, but as one potential step forward toward improving outcomes.
Using placements, signage, and other patient-facing strategies based on appealing to the less perceptive needs of men could increase patient hand hygiene compliance. The most important thing is doing what shows results, and building further strategies on those results.
Implementing an infection prevention program based on the latest research into what appears to work, with tests, measures and iterates to provide consistently better outcomes, is the path toward eradicating roaming pathogens.
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