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. 2022 Oct;17(7):1899-1905.
doi: 10.1007/s11739-022-03024-7. Epub 2022 Jul 19.

A nudge intervention to improve hand hygiene compliance in the hospital

Fabrizio Elia  1 , Fabrizio Calzavarini  2 , Paola Bianco  3 , Renata Gabriella Vecchietti  3 , Antonio Franco Macor  4 , Alessia D'Orazio  5 , Antonella Dragonetti  6 , Alessandra D'Alfonso  7 , Laura Belletrutti  7 , Mara Floris  8 , Fabrizio Bert  9 , Vincenzo Crupi  8 , Franco Aprà  5
Affiliations

A nudge intervention to improve hand hygiene compliance in the hospital

Fabrizio Elia et al. Intern Emerg Med. 2022 Oct.

Abstract

Hand hygiene among professionals plays a crucial role in preventing healthcare-associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.

Keywords: Decision-making; Hand hygiene; Infection prevention; Nudge.

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Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Additional dispenser at the foot of patient’s bed and visual reminder
Fig. 2
Fig. 2
Poster promoting hand hygiene
See this image and copyright information in PMC

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