TY - JOUR
T1 - Nudging to improve hand hygiene
AU - Caris, M G
AU - Labuschagne, H A
AU - Dekker, M
AU - Kramer, M H H
AU - van Agtmael, M A
AU - Vandenbroucke-Grauls, C M J E
PY - 2018/4
Y1 - 2018/4
N2 - BACKGROUND: Hand hygiene is paramount to prevent healthcare-associated infections, but improving compliance is challenging. When healthcare workers seldom encounter healthcare-associated infections, they will consider the odds of causing infections through poor hand hygiene negligible. Cognitive biases such as these may induce non-compliance. Nudging, 'a friendly push to encourage desired behaviour', could provide an easily implemented, inexpensive measure to address cognitive biases and thus support hand hygiene interventions.AIM: To investigate whether behavioural nudges, displayed as posters, can increase the use of alcohol-based hand rub.METHODS: We developed nudges based on a systematic review of previously described cognitive biases, and tested these through a cross-sectional survey among the target audience. We then conducted a controlled before-after trial on two hospital wards, to assess the effect of these nudges on the use of alcohol-based hand rub, measured with electronic dispensers.FINDINGS: Poisson regression analyses adjusted for workload showed that nudges displayed next to dispensers increased their overall use on one ward [poster 1: relative risk: 1.6 (95% confidence interval: 1.2-2.2); poster 2: 1.7 (1.2-2.5)] and during doctor's rounds on both wards [poster 1: ward A: 1.7 (1.1-2.6); ward B: 2.2 (1.3-3.8)]. Use of dispensers without adjacent nudges did not increase.CONCLUSION: Nudges based on cognitive biases that play a role in hand hygiene, and displayed as posters, could provide an easy, inexpensive measure to increase use of alcohol-based hand rub. When applying nudges to change behaviour, it is important to identify the right nudge for the right audience.
AB - BACKGROUND: Hand hygiene is paramount to prevent healthcare-associated infections, but improving compliance is challenging. When healthcare workers seldom encounter healthcare-associated infections, they will consider the odds of causing infections through poor hand hygiene negligible. Cognitive biases such as these may induce non-compliance. Nudging, 'a friendly push to encourage desired behaviour', could provide an easily implemented, inexpensive measure to address cognitive biases and thus support hand hygiene interventions.AIM: To investigate whether behavioural nudges, displayed as posters, can increase the use of alcohol-based hand rub.METHODS: We developed nudges based on a systematic review of previously described cognitive biases, and tested these through a cross-sectional survey among the target audience. We then conducted a controlled before-after trial on two hospital wards, to assess the effect of these nudges on the use of alcohol-based hand rub, measured with electronic dispensers.FINDINGS: Poisson regression analyses adjusted for workload showed that nudges displayed next to dispensers increased their overall use on one ward [poster 1: relative risk: 1.6 (95% confidence interval: 1.2-2.2); poster 2: 1.7 (1.2-2.5)] and during doctor's rounds on both wards [poster 1: ward A: 1.7 (1.1-2.6); ward B: 2.2 (1.3-3.8)]. Use of dispensers without adjacent nudges did not increase.CONCLUSION: Nudges based on cognitive biases that play a role in hand hygiene, and displayed as posters, could provide an easy, inexpensive measure to increase use of alcohol-based hand rub. When applying nudges to change behaviour, it is important to identify the right nudge for the right audience.
KW - Behavior Therapy/methods
KW - Controlled Before-After Studies
KW - Cross Infection/prevention & control
KW - Cross-Sectional Studies
KW - Guideline Adherence
KW - Hand Hygiene/methods
KW - Humans
KW - Surveys and Questionnaires
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85035055758&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/28974467
U2 - https://doi.org/10.1016/j.jhin.2017.09.023
DO - https://doi.org/10.1016/j.jhin.2017.09.023
M3 - Article
C2 - 28974467
SN - 0195-6701
VL - 98
SP - 352
EP - 358
JO - Journal of hospital infection
JF - Journal of hospital infection
IS - 4
ER -