Table 4.

Data extraction table. Themes from analysis

Reference	Patient role (vulnerable)	Patient role (responsible)	Patient role (expert)	Patient role (observer)	Passive level of patient involvement	Active level of patient involvement	Barriers on healthcare provider (HCP) and patients relationships
Hill et al 19	x	x		x	Repetition or asking the patient to repeat back in their own words or demonstrates that they have absorbed the information.	Encouraged patients to actively engage with their provider by asking about their methicillin-resistant Staphylococcus aureus status. Hand hygiene checklist which requires the patient to demonstrate their hand hygiene technique to a nurse.	Patient can have fear of a negative response from their HCP. Perception that caregivers already know (or should know) when to perform hand hygiene. The belief that asking about hand hygiene is not part of the patient’s role. Feeling of embarrassment or awkwardness associated with asking about hand hygiene.
McGuckin and Govednik6		x		x	Printed matter, oral demonstrations, audiovisual means.	Visual reminders to encourage patients to ask HCP. Set of strategies for developing a culture of shared responsibility to support patient involvement.	Fear of reprisals was the most frequent reason to do not ask HCP about IPC.
See et al 28		x	x		Print materials, DVDs, support groups and classes.	Partner with patients in infection control activities (eg, patients performing audits of infection control practices) Patient educating other patients about their experiences on infection prevention. This is facilitated by the oral culture of dialysis clinics (eg, with patients talking in the lobby).	Patients can feel uncomfortable speaking to their providers.
Loveday et al 27	x			x	Ensure patients, relatives and carers are given information regarding the reason for the catheter and the plan for review and removal.
Wyer et al 22		x	x			Viewing and discussing video footage of clinical care (involving patients and HCP).	Lack of conversation between patients and clinicians about IPC, and patients being ignored or contradicted when challenging perceived suboptimal practice.
Seale et al 21		x	x	x		Use of messages to encourage patients to ask questions about HCAIs, preventing infections, how to HH, signs and symptoms of infection, wound care.
Davis et al 11		x		x		HCP encouragement of both lay and expert patients to question their HH.	‘Patients reported that HCP laughed at them, became angry or ignored their request to clean their hands’ (p.158).
Seale et al 7		x	x	x	‘Adhering to what they have been told to do’ (eg, maintaining general hygiene and HH, not sharing items with other patients)’ (p.265).	Informing staff if their wounds had become red or inflamed, using personal protective equipment, reporting issues with cleanliness) and prompting staff about their HH practices.	HCPs feel a lack of support, busy workloads, and negative attitudes as key barriers to the implementation of any empowerment/involvement programmes.
Miller et al 26	x	x	x	x		Workshop with patients to get their expertise in the development of guidelines.	‘Patients and caregivers were concerned that disclosing information may impact on the care they receive from health professionals’ (p.218).
Tartari et al 18		x	x	x	Leaflet with information on preoperative, intraoperative and postoperative activities for the prevention of surgical site infections (SSIs).	Leaflet stating pragmatic recommendations to promote the participatory role of patients in IPC and encouraging patients to speak up. Encouraging an educational environment that stimulates patients to participate in their surgical care, inviting and allowing time for questions and clarifications on the information provided.	HCPs support and encouragement is crucial for successful patient involvement activities surrounding SSI prevention.
Cheng et al 20	x	x		x	Patient was educated by ICNs for 10–15 min on the following: importance of hand hygiene during hospitalisation.	Patients are encouraged to remind HCPs to perform hand hygiene. Patients shy to ask are provided with a 4-inch printed visual aid with ‘Did You Clean Your Hands?’	HCP expressed fear of conflicts between them and patients introduced by the empowerment programme.
Dadich and Wyer5		x	x			Suggest video reflexive ethnography and citizen social science as collaborative methodologies to improve practices by harnessing the expertise of individuals traditionally deemed as research subjects like patients and members of the public.
Alzyood et al 9		x		x	Video and leaflets to encourage patient involvement in safety-related behaviours.	Strategies to enable patients to speak up (eg, ‘It’s OK to Ask’ campaign, Thanks for Washing’ script and badges ‘Ask me if I’ve washed my hands’).	The active role of patients to speak up is challenging to both patients and staff. Staff feeling discomfort and distress if prompted to perform hand hygiene by patients.
Butenko et al 10	x	x		x	Organisation enablers for patient involvement in infection prevention and control (IPC): equipment, sinks, information sheets, educational videos.		Patients have reluctance to partner due to a perceived lack of knowledge and fear of retribution from HCP. Behaviours of HCP and prevailing culture did not support HH interventions partnering with patients.

DVD, digital video disc; ICN, infection control nurses.