Improving Hand Hygiene Compliance

Correct compliance with hand hygiene practices is a crucial way of minimising the risk of hospital acquired infections for patients. However, it was noted that there was room for improvement in this practice.

To explore the target behaviour, we began with a literature review of previous behavioural initiatives in this field, followed by a focus group with Infection control staff to further understand barriers to compliance. We conducted 18 hours of ethnographic observation on three hospital wards, focusing on WHO moments for hand hygiene 1 and 5. We wound that around 42% of these moments were compliant.
Barriers to correct hand hygiene elicited included:
- Forgetting
- Interruptions during a task / process
- Using gloves as an alternative
- Lack of role-modelling by senior staff
- Limited bandwidth
- Different baseline “norms” - those recruited post COVID-19

We also identified three key areas where hand hygiene failed:
- The approach to the patient’s bed
- Glove use
- The computer on wheels

We ran a series of co-design workshops, hosted with Infection control teams, Behavioural Scientists, Senior nurses, Designers and Frontline staff, and shortlisted 11 ideas for an innovative intervention. These were reviewed using the behaviour change wheel, and refined using impact and feasibility criteria

Ideas selected
Physical Prompts
Addressing the use of gloves
Patient empowerment
These were mapped to the three key areas identified in explore where compliance failed

Stickers were designed in line with trust requirements
Intervention launched on three target wards
6 week duration of trial period
18 hours of observation undertaken
11% increase in compliance overall (U=94.5, p=0.033)
Different effect on different wards within the study
Increase in both moment 1 and 5, but significant for moment 1