Study: Providers See the Light and Hand Hygiene Improves

One of the problems with getting healthcare workers (HCWs) to comply with hand hygiene protocols, according to a pre-press study in the American Journal of Infection Control, is that the providers don’t necessarily follow cause and effect. The consequences of poor hand hygiene on the part of doctors and nurses might not be seen in their patients until days later “and they could consider their risk of causing infections negligible.”

Danish investigators wanted to see if a nudge provided by lights on dispensers of alcohol-based disinfectant would improve the compliance of nurses and doctors in a 29-bed hospital surgical department. The study used a device called a Sani nudge between February 2018 and April 2019. The investigators note that hand hygiene compliance had been low for both nurses and doctors, with doctors having the lowest baseline compliance rate. The baseline compliance for doctors was 16% in patient rooms and 24% in other rooms on the ward. The baseline compliance rate for nurses was 27% in patient rooms and 39% in the other rooms on the ward.

Investigators observed how compliance improved among the 26 nurses and 10 doctors involved in the study. The short answer is that compliance improved greatly.

After the installation of the light-guided nudging devices, doctor compliance with hand hygiene protocols “increased significantly to 42% (p < 0.0001) in the patient rooms and to 78% (p = 0.0006) in all other situations once the nudging feature was activated and the group performance feedback used,” the study states.

Hand hygiene compliance also increase significantly for the nurses “to 43% (p = 0.0002) in the patient rooms and to 64% (p < 0.0001) in all other situations once the nudging feature was activated and the group performance feedback provided…. The HHC of the nurses receiving individual performance feedback further increased to 55% (p < 0.0001) in the patient rooms and to 80% (p < 0.0001) in all other situations compared with the period when group level data and nudging were provided.”

The Sani nudge device sensor was placed on dispensers that noted the number of times a provider, who wore a sensor on her or his ID badge, would have “rubbing events” and what the study calls a “green smiley” would light up as a reward. The sensors on the badges indicated whether the wearer was a nurse or doctor. Sensors were also placed near the heads of patients’ beds. The information on the sensors was sent to a cloud-based computer server. “Weekly performance data on group level is sent to the infection control nurses and ward managers, shown at staff meetings and put up on bulletin boards,” the study states.

The study also states that “the doctors had the lowest baseline compliance but seemed to be very responsive to the intervention and reached the same compliance levels as the nurses in the patient rooms and even higher levels in the working rooms. However, the nurses receiving individual performance feedback demonstrated the best performance in all the different room types.”