Claudia James

Best practiceHand hygiene

“Hand hygiene is always good news for your patients”

Do good and talk about it: In her “Hygiene Communication Concept”, Claudia James, hygiene-specialist and managing director at HyTrain GmbH, explains how communication can improve hand hygiene compliance of physicians and nursing staff. By voicing hand disinfection staff shapes own hygiene behaviour and at the same time gives patients valuable insights into possibilities to participate in their own healing process. In our interview, the expert describes the background to her findings and gives specific instructions for putting these into practice.

What is behind the idea of hygiene communication? Is it really new?

Claudia James: In principle, hygiene communication is talking about hand disinfection – at the very moment doctors and health professionals disinfect their hands to protect patients. For patients this message is valuable. Additionally, it opens up the chance for healthcare staff to explain to patients when it makes sense for them to perform hand hygiene to support their own getting well. What is new about the concept is that it combines linguistic aspects with hygiene. Because talking about something makes it real.

How does this work in practice? What exactly should medical staff say?

James: During the treatment and care of patients, doctors and nurses should disinfect their hands in various situations. But not all these moments are equally important for patient protection. In some situations, hand disinfection is primarily aimed at protecting staff and in other situations, it is intended to protect patients. Moments that are particularly relevant for patient protection are, for example, those in which the physician or medical staff member approaches and touches patients, or moments prior to aseptic treatment, for example just before wound care. This is why they are referred to as “pre-indications”. At such times, doctors, nurses and their patients often already talk to each other anyway. This is also precisely the moment medical staff can inform patients about hand disinfection.

For example, one way to say this is: “Hello, I’m going to take a look at your wound. But first, I’m going to disinfect my hands to prevent any germ transmission.” This has several effects. The first thing is that as soon as I talk about hand disinfection, I have to implement it. At the same time, I have conveyed good news to the patient, who then relaxes a bit and we can possibly start a conversation. Relatives can also be involved very well in such situations. Because not only the hospital staff can spread microorganisms, but of course, also any other person who moves around in the hospital and touches things and surfaces. The conversation could begin like this: “I’m going to have a look at your catheter. I will disinfect my hands first, because we don’t want to transmit any germs to it. By the way, it also makes sense for you to disinfect your hands, too, in certain situations – such as before eating, and after cleaning your nose, or going to the toilet. I’ll be happy to tell you more."

Which impulse or idea gave rise to your “hygiene communication concept”?

James: Hand hygiene and compliance are topics I have been dealing with professionally for 20 years. During this time, the importance of hand disinfection has increased dramatically. Great progress has been made, but obstacles to implementation still exist. Increasingly, research is looking at psycho-social factors in this context. Some time ago, I visited someone in hospital – as a friend, not as a health professional – and naturally sat by her bed for a while. During this time, the nurse and a doctor came into the room and had conversations with the patients, as one would wish. While they were there, they fluffed the pillow, lowered the bed, checked the catheter and performed various other activities on or near the patient. The staff accompanied all their activities with words, explaining what they were doing and why. It struck me, however, that hand disinfection – when it took place – was carried out in a complete silence. At that moment, it became clear to me that this was a missed opportunity to positively influence behaviour, as well as to pass on very positive and calming information to the patient. As a linguist, I asked myself whether in this case, language could – more or less effortlessly – directly influence behaviour.

Benefits of the hygiene communication concept:

a) Talking about hand hygiene inevitably leads to its implementation and thus supports compliance.

b) Restricting hygiene communication to “pre-indications” covers moments that are essential for patient protection. At the same time, this also prevents redundancy in messaging.

c) The staff delivers a positive, supportive message to the patients. This should not be underestimated, as patient reported outcome (PRO) has a firm place in research, patient protection organisations and health insurance.

d) The caring, competent and proactive role of the staff is strengthened.

e) Ongoing patient care and treatment is neither interrupted nor prolonged but is simply supported by communication. Information on hand disinfection is integrated naturally into the routine of patient care and treatment.

f) Patients and staff in the immediate vicinity perceive this respectful form of communication and subsequently anticipate the same behaviour again.

g) Active hygiene communication can also lead to a dialogue with patients and subsequent guidance on how they can perform meaningful hand disinfection.

Have studies on hygiene communication already been carried out?

James: No, not yet. It is currently explicitly a concept – a proposal intended to enrich the discussion and nudge the thinking in a new direction. However, scientific literature indicates that patients appreciate it when staff informs them about hand hygiene during or shortly after hospital admission. Yet I would find it very exciting indeed to scientifically investigate the effect of hand hygiene communication on the compliance behaviour of doctors and nurses, as well as on the well-being of patients.

What do you think is important for a successful implementation in practice?

James: The right training! Patient protection depends on many small actions that must be performed in the correct order and in the right way – including hand hygiene. And this really is not trivial, it has to be practiced. From my point of view, it is also important to train hygiene communication directly by using example activities. This can be combined with other training content on the subject of communication. Because communication with patients is an interesting and important field. We have certainly all experienced for ourselves that a good and sufficient explanation by doctors or nursing staff can calm patients. As the term “patient care” implies, care is important – and here hand hygiene is always good news.

Find the publication here:

“Hygiene Communication Concept”

Further Information

  1. Hand hygiene communication from healthcare workers to patients: results of a pilot survey in several healthcare facilities., Verjat-Trannoy, D et al., Antimicrobial Resistance and Infection Control vol. 2, Suppl 1 P148. June 2013
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