Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-04T21:10:29.871Z Has data issue: false hasContentIssue false
  • English
  • Français

The effect of eye images and a social norms message on healthcare provider hand hygiene adherence

Published online by Cambridge University Press:  10 May 2019

Sarah A. Stella Open the ORCID record for Sarah A. Stella [Opens in a new window] ,
Roger J. Stace ,
Bryan C. Knepper ,
Sara M. Reese ,
Angela Keniston ,
Marisha Burden  and
Heather L. Young
Sarah A. Stella*
Affiliation:
Department of Medicine, Denver Health Medical Center, Denver, Colorado Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
Roger J. Stace
Affiliation:
University of Colorado Denver Business School, Denver, Colorado
Bryan C. Knepper
Affiliation:
Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado
Sara M. Reese
Affiliation:
Department of Quality, Swedish Medical Center, Englewood, Colorado
Angela Keniston
Affiliation:
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
Marisha Burden
Affiliation:
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
Heather L. Young
Affiliation:
Department of Medicine, Denver Health Medical Center, Denver, Colorado Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado
*
Author for correspondence: Sarah A. Stella, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Depictions of eye images and messages encouraging compliance with social norms have successfully motivated behavioral change in a variety of experimental and applied settings. We studied the effect of these 2 visual cues on hand hygiene adherence in a cohort of hospital-based healthcare providers participating in an electronic monitoring and feedback program.

Methods:

Prospective, quasi-experimental study utilizing an interrupted time-series design. Intervention placards depicting an image of eyes, a social norms message, or a control placard were placed near soap and alcohol-based hand-rub dispensers on 2 hospital units. Placards were alternated every 10 days. Hand hygiene opportunities and adherence rates were assessed electronically via the CenTrak Hand Hygiene Compliance Solution.

Results:

A total of 166 nurses and certified nursing assistants (74 on a medical-surgical unit and 92 on a progressive care unit) were monitored electronically over the 4-month study period. In total, 184,172 electronic observations were collected (110,903 on a medical-surgical unit and 73,269 on a progressive care unit). The median daily number of electronic observations was 1,471 (interquartile range, 1,337–1,584). The preintervention baseline hand hygiene adherence rate was 70%. No statistically significant increase in hand hygiene adherence was observed as a result of either intervention.

Conclusion:

Displaying eye images or a social norms message in the hospital environment did not result in measurable improvements in HH adherence in a cohort of healthcare providers participating in an electronic monitoring and feedback program.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 7 , July 2019 , pp. 748 - 754
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allegranzi, B, Pittet, D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2010;73:305–315.CrossRefGoogle Scholar
Barnes, SL, Morgan, DJ, Harris, AD, Carling, PC, Thom, KA. Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions. Infect Control Hosp Epidemiol 2014;35:1156–1162.CrossRefGoogle ScholarPubMed
Erasmus, V, Daha, TJ, Brug, H, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283–294.CrossRefGoogle ScholarPubMed
WHO guidelines on hand hygiene in health care: first global patient safety challenge- clean care is safer care. World Health Organization website. http://www.who.int/gpsc/5may/tools/9789241597906/en/ Published 2009. Accessed April 20, 2016.Google Scholar
Schweitzer, M, Schacht Reisinger, H, Ohl, M, et al. Searching for an optimal hand hygiene bundle: A meta analysis. Clin Infect Dis 2014;58:248–259.CrossRefGoogle Scholar
Ellingson, K, Haas, J, Aiello, A, et al. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol 2014:35:937–960.CrossRefGoogle ScholarPubMed
Srigley, J, Gardam, M, Fernie, G, Lightfoot, D, Lebovic, G, Muller, M. Hand hygiene monitoring technology: a systematic review of efficacy. J Hosp Infect 2015;89:51–60.CrossRefGoogle Scholar
Edmisten, C, Hall, C, Kernizan, L, et al. Implementing an electronic hand hygiene monitoring system: lessons learned from community hospitals. Am J Infect Control 2017;45:860–865.CrossRefGoogle ScholarPubMed
Haley, KJ, Fessler DMT. Nobody’s watching? Subtle cues affect generosity in an anonymous economic game. Evol Human Behav 2005;26:245–256.CrossRefGoogle Scholar
Bateson, M, Nettle, D, Roberts, G. Cues of being watched enhance co-operation in a real-world setting. Biol Lett 2006;2:412–414.CrossRefGoogle Scholar
Ernest-Jones, M, Nettle, D, Bateson, M Effects of eye images on everyday cooperative behavior: a field experiment. Evol Human Behav 2011;32:172–178.CrossRefGoogle Scholar
Eckmanns, T, Bessert, J, Behnke, M, et al. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:931–934.CrossRefGoogle ScholarPubMed
Beyfus, TA, Drawson, MD, Danner, CH, et al. The use of passive visual stimuli to enhance compliance with handwashing in a perioperative setting. Am J Infect Control 2016;44:496–499.CrossRefGoogle Scholar
Bolton, PGM, Rivas, K, Prachar, V, et al. The observer effect: can being watched enhance compliance with hand hygiene behavior? A randomized trial. Asia Pac J Health Manag 2015;10:GS14–GS15.Google Scholar
King, D, Vlaev, I, Everett-Thomas, R, et al. “Priming” hand hygiene compliance in clinical environments. Health Psychol 2016;35:96–101.CrossRefGoogle ScholarPubMed
Gaube, S, Tsivrikos, D, Dollinger, D, Lermer, E. How a smiley protects health: a pilot intervention to improve hand hygiene in hospitals by activating injunctive norms through emoticons. PLoS One 2018;13:e0197465.CrossRefGoogle ScholarPubMed
Loewenstein, G, Asch, DA, Friedman, JY, Melichar, LA, Volpp, KG. Can behavioural economics make us healthier? BMJ 2012;344–346.Google ScholarPubMed
Matjasko, JL, Cawley, JH, Baker-Goering, MM, Yokum, DV. Applying behavioral economics to public health policy. Am J Prev Med 2016;50:S13–S19.CrossRefGoogle ScholarPubMed
Goldstein, NJ, Cialdini, R, Griskevicius, V. A room with a viewpoint: using social norms to motivate environmental conservation in hotels. J Consumer Res 2008;35:472–482.CrossRefGoogle Scholar
Ayres, I, Raseman, S, Shih, A. Evidence from two large field experiments that peer comparison feedback can reduce residential energy usage. J Law Econ Org 2013;29:992–1022.CrossRefGoogle Scholar
Ferraro, P, Price, M. Using nonpecuniary strategies to influence behavior: evidence from a large-scale field experiment. Rev Econ Statist 2013;95:64–73.CrossRefGoogle Scholar
Huis, A, Schoonhoven, L, Grol, R, Donders, R, Hulscher, M, van Achterberg, T. Impact of a team and leaders-directed strategy to improve nurses’ adherence with hand hygiene guidelines: a cluster randomised trial. Int J Nurs Stud 2013;50:464–474.CrossRefGoogle ScholarPubMed
Armellino, D, Hussain, E, Schilling, ME, et al. Using high-technology to enforce low-technology safety measures: the use of third party remote video auditing and real-time feedback in healthcare. Clin Infect Dis 2012;54:1–7.CrossRefGoogle Scholar
WHO Five Moments for Hand Hygiene. World Health Organization website. http://www.who.int/gpsc/tools/Five_moments/en/ Published 2006. Accessed September 29, 2016.Google Scholar
CenTrak hand hygiene compliance solution. CenTrak website. https://www.centrak.com/handhygiene-compliance/. Accessed December 3, 2018.Google Scholar
Gould, DJ, Moralejo, D, Drey, N, Chudleigh, JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Systemat Rev 2010;9:CD005186.Google Scholar
Supplementary material: Image

Stella et al. supplementary material

Stella et al. supplementary material 1

Download Stella et al. supplementary material(Image)
Image 19.7 MB