Patient participation strategies associated with improved patient participation and hand hygiene behaviors in a university hospital

Infection prevention in healthcare settings depends not only on the practices of healthcare workers but also on patients’ active participation in safety protocols. While the literature has generally addressed patient participation in care practices, evidence regarding patient participation in infection prevention practices, particularly hand hygiene, remains limited. This study aimed to examine changes in patients’ level of participation in patient safety practices and hand hygiene behaviors following the implementation of patient participation strategies for infection prevention. This quasi-experimental and observational study constituted the third and fourth phases of a four-phase doctoral dissertation project for which ethical approval was obtained on 21 May 2021. These two phases were conducted at a university hospital in Turkey between February and April 2025. A total of 58 patients were included. The 696 records represented repeated participant–occasion observations from the same patients and were not independent observations. Data were collected using the Demographic Characteristics Questionnaire, the Patient Participation in Patient Safety Practices Scale (infection subscale), and the Hand Hygiene Observation Form. Data were analyzed using descriptive statistics, the Wilcoxon signed-rank test, Cochran Q test, and McNemar test, with a significance level of p < .05. Patient participation scores increased significantly following the intervention (14.83 ± 3.65 vs. 18.12 ± 2.84; p < .001), with a large effect size (r = .79). After adjustment for multiple comparisons using the Holm method, significant improvements were observed in several hand hygiene steps requiring technical accuracy. For alcohol-based hand rub, improvements in backs of fingers to opposing palms, rotational rubbing of thumbs, and fingertips-to-palm rubbing remained significant across daytime, nighttime, and weekend observations. For soap-and-water hand hygiene, significant improvements were also observed in several technical steps, although not all comparisons remained significant across all observation periods. Structured strategies that promote patient participation can be effective in fostering safe behaviors aimed at preventing infections. Encouraging patients to actively participate in safety practices, such as hand hygiene, can help strengthen patient safety and infection prevention practices in healthcare settings.