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. 2023 Aug;94(2):450-457.
doi: 10.1038/s41390-023-02482-9. Epub 2023 Jan 24.

Developing a design-based concept to improve hand hygiene in the neonatal intensive care unit

Sophie J Jansen  1 , Britt J Müller  2 , Sophie J E Cramer  3 , Arjan B Te Pas  3 , Enrico Lopriore  3 , Vincent Bekker  3
Affiliations

Developing a design-based concept to improve hand hygiene in the neonatal intensive care unit

Sophie J Jansen et al. Pediatr Res. 2023 Aug.

Abstract

Background: Hand hygiene (HH) is the most critical measure in the prevention of nosocomial infections in the neonatal intensive care unit (NICU). Improving and sustaining adequate HH compliance rates, however, remains a significant challenge. Using a behavioral change framework and nudge theory, we developed a design-based concept aimed at facilitating and stimulating HH behavior.

Methods: Concept development was initiated by selecting a theoretical framework after which contextual field studies aimed at discovering causes for poor compliance were conducted. Potential solutions were brainstormed upon during focus group sessions. Low-fidelity prototypes were tested regarding feasibility, usability, and acceptability. A final concept was crafted drawing from findings from each design phase.

Results: Complying with recommended HH guidelines is unrealistic and infeasible due to frequent competing (clinical) priorities requiring HH. The concept "Island-based nursing," where a patient room is divided into two geographical areas, namely, the island and general zone, was created. HH must be performed upon entering and exiting the island zone, and after exposure to any surface within the general zone. Reminding of HH is prompted by illuminated demarcation of the island zone, serving as the concept's nudge.

Conclusions: Island zone demarcation facilitates and economizes HH indications in an innovative and intuitive manner.

Impact: Although hand hygiene (HH) is the single most important element in the prevention of nosocomial infections in neonates, improving and sustaining adequate HH compliance rates remains a significant challenge. Complying with recommended HH guidelines was found to be unrealistic and infeasible due to the significant amount of time required for HH in a setting with a high workload and many competing (clinical) priorities. The concept of "Island-based nursing," under which the primary HH indication is upon entering and exiting the island zone, facilitates and economizes HH indications in an innovative and user-friendly manner.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. The Integrated Behavior Model.
The model features the original as well as  four additional constructs that directly affect behavior.
Fig. 2
Fig. 2. Low-fidelity prototypes of the five preliminary concepts.
Each individual concept features a dynamic light source yet differs regarding the location of the light source, type of feedback given and timing of the intervention.
Fig. 3
Fig. 3. Final design concept of “Island-based nursing”.
a, b Visualize the concept implemented in a single-patient room twin-room, respectively. Patient zone defined as the patient and his/her immediate surroundings colonized by a patient flora and healthcare zone containing all other surfaces within a single-patient or twin-room.
Fig. 4
Fig. 4. Nudging component of the “Island-based nursing” concept.
Illuminated line, created by the laser projector suspended from the ceiling, demarcates the boundaries of the island zone.
See this image and copyright information in PMC

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