Nudging hand hygiene compliance: a large-scale field experiment on hospital visitors

A Cross-Sectional Study and Observational Assessment of Shoppers' COVID-19 Prevention Behaviors in Southwestern Ontario, Canada

OBJECTIVE

The aim of this study was to observe the level of alcohol-based sanitizer, mask use, and physical distancing across indoor community settings in Guelph, ON, Canada, and to identify potential barriers to practicing these behaviors.

METHODS

Shoppers were observed in June 2022 across 21 establishments. Discrete in-person observations were conducted and electronically recorded using smartphones. Multilevel logistic regression models were fitted to identify possible covariates for the 3 behavioral outcomes.

RESULTS

Of 946 observed shoppers, 69% shopped alone, 72% had at least 1 hand occupied, 26% touched their face, 29% physically distanced ≥ 2 m, 6% used hand sanitizer, and 29% wore masks. Sanitizer use was more commonly observed among people who wore masks and in establishments with coronavirus disease (COVID-19) signage posted at the entrance. Mask use was more commonly observed during days without precipitation and in establishments with some or all touch-free entrances. Shoppers more commonly physically distanced ≥ 2 m when they were shopping alone.

CONCLUSIONS

This supports evidence for environmental context influencing COVID-19 preventive behaviors. Intervention efforts aimed at visible signage, tailored messaging, and redesigning spaces to facilitate preventive behaviors may be effective at increasing adherence during outbreaks.

COMPLIANCE OF PATIENT COMPANIONS AND VISITORS WITH HAND HYGIENE: AN OBSERVATIONAL STUDY

BACKGROUND

Hand hygiene is a simple and low-cost practice to prevent the spread of many microorganisms that cause healthcare-associated infections (HCAIs). Compliance with hand hygiene, especially by patient companions and visitors, is very important in order to prevent the transmission of pathogenic microorganisms between the health institutions and the community.

AIM

This is a descriptive study designed to investigate the compliance of patient companions and visitors with hand hygiene.

METHODS

The sample of the study included 209 individuals who were the companions and visitors of the patients who were hospitalized in a University Hospital in the west of Turkey. A questionnaire containing Demographics and Hand Hygiene and the Observation Form to assess Hand Hygiene Practice were used to acquire data. In order to conduct the research, permission was obtained from the ethics committee and the institution, and consent was obtained from the patient companions and visitors. To evaluate the data, the numbers, percentage calculations, mean and independent inter-observer agreement coefficient were used.

FINDINGS

96.2% of the patient companions and visitors stated that they did not receive training on the importance of hand washing during their stay in the hospital, and 74.6% stated that hand washing was very important in the prevention of diseases. The patient families reported that they most often washed their hands after touching bodily fluids (91.7%), and that they rarely washed their hands before touching a patient (34.0%). The rates were decreased in the observations, and the lowest rate for handwashing was before touching a patient (22.4%) and the highest rate for handwashing was after the risk for contamination with body fluids of patient (68.6%).

CONCLUSION

The results of this study indicate that patient companions and visitors did not receive any training on the importance of hand hygiene during the hospital stay, and the observed rate of compliance with hand hygiene was lower than stated. Recommendations include delivering planned handwashing training to patient companions and visitors using different teaching methods, and to conduct longer observational studies.

Using nudges to promote clinical decision making of healthcare professionals: A scoping review

Nudging has been discussed in the context of policy and public health, but not so much within healthcare. This scoping review aimed to assess the empirical evidence on how nudging techniques can be used to affect the behavior of healthcare professionals (HCPs) in clinical settings. A systematic database search was conducted for the period January 2010-December 2020 using the PRISMA extension for Scoping Review checklist. Two reviewers independently screened each article for inclusion. Included articles were reviewed to extract key information about each intervention, including purpose, target behavior, measured outcomes, key findings, nudging strategies, intervention objectives and their theoretical underpinnings. Two independent dimensions, building on Kahneman's System 1 and System 2, were used to describe nudging strategies according to user action and timing of their implementation. Of the included 51 articles, 40 reported statistically significant results, six were not significant and two reported mixed results. Thirteen different nudging strategies were identified aimed at modifying four types of HPCs' behavior: prescriptions and orders, procedure, hand hygiene, and vaccination. The most common nudging strategy employed were defaults or pre-orders, followed by alerts or reminders, and active choice. Many interventions did not require any deliberate action from users, here termed passive interventions, such as automatically changing prescriptions to their generic equivalent unless indicated by the user. Passive nudges may be successful in changing the target outcome but may go unnoticed by the user. Future work should consider the broader ethical implications of passive nudges.

BSAC Vanguard Series: Behavioural science and antimicrobial resistance

Antimicrobial resistance could cause 10 million deaths per year by 2050 if no action is taken. While we depend on researchers to find new antimicrobials, reducing the demand for existing ones requires human behaviour change. This article by The Behavioural Insights Team discusses some of the areas with the greatest potential for behavioural interventions to reduce the development of antimicrobial resistance. Three areas are discussed: (i) ‘nudging’ antimicrobial stewardship (e.g. highlighting comparative over-prescribing was seen to reduce GP antibiotics prescriptions by 3.3%); (ii) promoting good hygiene practices (e.g. placement and salience of hand sanitizer increased hospital visitor compliance from 0.4% to 19.7%); and (iii) leveraging market forces (e.g. front-of-package labelling could increase demand for meat produced with minimal antibiotics, encouraging food production behaviour change).