Study reveal: Smileys improve hand hygiene in hospitals

Hospital Acquired Infections (HAI’s) are a growing global concern and a burden on healthcare systems worldwide. In Europe alone, 4 million HAI’s occur each year and in about 30 percent of all cases, the hands of healthcare workers are the main source of the infections.

Particularly in medical facilities, hand disinfection by hospital staff is considered a “safety belt” for the patient, as it is not uncommon for those treated to suffer from immunodeficiency. Despite efforts to increase awareness of the importance of proper hand hygiene among healthcare workers, everyday practice still falls short of improving compliance. The compliance rate is still averaging around 30- 40% in most medical facilities. Increased workload and lack of available disinfectants are some of the main challenges that face proper hand disinfection within medical facilities. But often it is simply a matter of where the healthcare workers attention is at.

Multimodal intervention have proven to be an effective method of sustainably improving hand hygiene behaviour. Isolated individual measures often fail because they only increase compliance in the short term and have no positive long-term effects. Easy access to hand disinfectant dispensers, needs-based training, and the involvement of hand hygiene managers are important components of the multimodal approach, however, they alone have proven not to be adequate.

Electronic monitoring systems such as the Sani Nudge system enable those responsible for hygiene to track hand hygiene behaviour of doctors and nursing staff in a timely manner and see where their hand hygiene needs improvement. Yet the psychological component to hygiene is playing an increasingly important role, and with hand hygiene data available at the push of a button, it is becoming easier to improve compliance rates in health care environments.

Better understanding behavioral changes for hand disinfection in everyday clinical practice aided by learning more about user interactions with visual cues and rewards. A research team from the University of Regensburg, the Technical University of Munich and the University College London took this opportunity to investigate the influence of cues and rewards on hand hygiene behaviour.

In a surgical ward of the Rottal-Inn Kliniken in Eggenfelden, Bavaria, eight out of sixteen patient rooms were selected for the installation of screens that provide visual feedback after hand disinfection. The screens were installed in the immediate vicinity and above the hand disinfectant dispensers. Similar to how the nudging of the Sani sensors work, every time a healthcare worker used the dispenser they were presented with a Smiley.

The study was divided into a baseline and an intervention phase. In the baseline phase, the number of hand disinfectants was measured over eight weeks without intervention.  The subsequent intervention phase lasted nine weeks.

The results were that the number of hand disinfectants in the two patient rooms with cues increased significantly compared to the baseline phase.

Implementation in everyday practice

What can we learn from the results? The visual feedback with smileys for hand hygiene behaviour can be used as a meaningful measure to increase hand hygiene compliance in everyday hospital life.

Compliance for hand hygiene plays a very important role in patient safety, especially in hygiene-sensitive wards. Combined with organizational and personnel factors, the psychological factor offers great potential for improving patient protection in hospitals.

You can find the original study here – Source: Gaube, Susanne, et al. “How a smiley protects health: A pilot intervention to improve hand hygiene in hospitals by activating injunctive norms through emoticons”. PloS one 13.5 (2018): e0197465.

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