Cues, Scents Can Help Boost Hand Hygiene Compliance

A picture of a man’s intense staring eyes and a clean citrusy smell have been found to substantially improve handwashing and so cut the risk of hospital infections, according to a new study. According to the latest research effective hand hygiene is the single most important procedure in preventing hospital acquired infections, which can lead to disease and even death for vulnerable patients and increase costs for the healthcare system. Yet the number of staff washing hands is often startlingly low in clinical environments.

Ivo Vlaev, of Warwick Business School, Dominic King and Ara Darzi, of Imperial College London, and Maureen Fitzpatrick, Ruth Everett-Thomas and David Birnbach, of the University of Miami, used insights from behavioral science – often called nudges – to improve rates of handwashing in a study at one hospital.

They found a picture of a man’s eyes saw one-third more people wash their hands, while a citrus smell boosted handwashing by almost 50 percent.

“Appropriate hand hygiene is considered to be essential practice in clinical environments to prevent healthcare-associated infections," Vlaev says. “Yet low rates of handwashing are widely reported and this was reconfirmed in this study, where only 15 percent of staff and visitors to an intensive care unit were observed to use the handwashing station.”

In the paper, "Priming’ Hand Hygiene Compliance in Clinical Environments," published in Health Psychology, the researchers experimented with psychological priming, which is the process where exposure to certain cues -- for example words, smells, or images -- alters behavior without the person being aware of the impact of the cue on their behavior.

A trial was set up in a surgical intensive care unit at a teaching hospital in Miami. A total of 404 healthcare workers and visitors were observed to see if they washed their hands by using the hand sanitizer next to the door before entering a patient’s room. In the control group, of 120 visitors just 18 washed their hands (15 percent). Men on the whole seemed far sloppier with only 5 out of 54 (9.26 percent) washing their hands, compared to 13 out of 66 women who washed their hands (19.70 percent). A total of 124 visitors were exposed to a visual cue of a pair of eyes positioned above the alcohol hand gel dispenser.

When exposed to a photograph of male eyes there was a statistically significant increase in handwashing of 33.3 percent. However, when the photograph was of female eyes even less, 10 percent, washed their hands. Again males tended to comply with hand hygiene far less than their female counterparts with 21 women influenced by the male or female eyes and only five men, with just one man motivated by the female eyes to wash his hands.

“This may be because male eyes cue different feelings, thoughts, or emotions than female eyes.," Vlaev says. "In many previous studies examining gender differences in exerting social influence more generally, men have been found to exert more influence than women and this may explain the differences seen. However, it is important to clarify the male eyes showed used more facial musculature, often perceived as anger or threat, so this could have influenced the observed individuals.”

There were 160 individuals observed who were exposed to a citrus smell and they were significantly more likely than the control group to wash their hands, with 46.9 percent using the alcohol hand gel dispenser. The citrus smell seemed to spur more men into action with 35 out of 83 males observed to wash their hands (42.17 percent). Females again complied more often, however, with 40 out 77 (51.95 percent) complying.

“Based on these preliminary findings, we believe that further research in this area should be performed in order to better determine whether priming interventions could be a powerful tool in encouraging handwashing to improve infection rates,” adds Vlaev. “Further work could look more fully at gender differences in response to priming-based interventions; whether healthcare workers are affected differently than visitors, and whether the impact is strengthened or diluted through repeated exposure.”

Source: University of Warwick