Hand Sanitation: Simple Oversight Improves Compliance

Nosocomial infection is an enormous issue in hospitals. Although the actual statistic seems small at first glance—1 in 25 patients acquire a health care-related infection while hospitalized—it translates to 75,000 unnecessary deaths annually. Hand washing and alternative hand sanitation are documented, effective preventive interventions. And simple. On the other hand, are they?

Many health care providers cut corners when it comes to hand sanitation. In fact, up to 60% of health care providers skip the soap and water or alcohol foam often enough to be considered health care risks. The American Journal of Infection Control has published a prospective, single-blind study that discusses this issue in the perioperative setting. Its focus is finding effective reminders to increase hand sanitation.

This research team works in the Mayo Clinic in Jacksonville, FL. Their interest was use of passive visual stimuli (meaningful pictures) to encourage handwashing.

They monitored and measured use of 4 of 54 wall-mounted alcohol foam dispensers. The dispensers were mounted in a high-traffic perianesthesia area. All dispensers delivered similar volumes of alcohol foam automatically when activated.

Acknowledging that multifaceted approaches are clearly needed to increase hand sanitation, they gathered data about various approaches. Visual stimuli seem to prompt automatic responses in target populations in many areas of study. They based their approach on a study that looked at visual stimuli as a reminder to contribute to a coffee fund (another activity that has low compliance rates). In that study, the eyes increased contributions to coffee cans.

The researchers did not tell perioperative staff about the study or its methods. They just posted the stimuli. They pasted pictures of eyes on dispensers designated #1 and #3 but not dispensers #2 and #4 for 1 time period. Although they didn't label the eyes, they belonged to one of the institution's popular though leaders and were recognizable as such. After a while, they moved the pictures to dispensers #2 and #4. They rotated the stimuli 6 times.

Dispensers that were accompanied by the visual stimuli used 279 mL of fluid on an average. Those that didn't used significantly less (246 mL).

Initially, someone removed and discarded the pictures, but the researchers replaced them and started over. The researchers have no idea if the intervention worked because it drew attention to the hand sanitation station, or because it implied behavioral oversight. Regardless, in this study, visual stimuli improved compliance with hand hygiene.