The effect of eye images and a social norms message on healthcare provider hand hygiene adherence

Abstract

Background:Depictions of eye images and messages encouraging compliance with social norms have successfully motivated behavioral change in a variety of experimental and applied settings. We studied the effect of these 2 visual cues on hand hygiene adherence in a cohort of hospital-based healthcare providers participating in an electronic monitoring and feedback program.Methods:Prospective, quasi-experimental study utilizing an interrupted time-series design. Intervention placards depicting an image of eyes, a social norms message, or a control placard were placed near soap and alcohol-based hand-rub dispensers on 2 hospital units. Placards were alternated every 10 days. Hand hygiene opportunities and adherence rates were assessed electronically via the CenTrak Hand Hygiene Compliance Solution.Results:A total of 166 nurses and certified nursing assistants (74 on a medical-surgical unit and 92 on a progressive care unit) were monitored electronically over the 4-month study period. In total, 184,172 electronic observations were collected (110,903 on a medical-surgical unit and 73,269 on a progressive care unit). The median daily number of electronic observations was 1,471 (interquartile range, 1,337–1,584). The preintervention baseline hand hygiene adherence rate was 70%. No statistically significant increase in hand hygiene adherence was observed as a result of either intervention.Conclusion:Displaying eye images or a social norms message in the hospital environment did not result in measurable improvements in HH adherence in a cohort of healthcare providers participating in an electronic monitoring and feedback program.

The effect of behavioural interventions targeting hand hygiene practices among nurses in high-income hospital settings: a systematic review

“…After duplicates were removed, 513 records were screened of which 477 were excluded due to not being a journal article, not being conducted in a HIC, or not evaluating HHC rates as the main outcome. The full text of the remaining 36 articles were assessed for eligibility resulting in a total of 7 studies (10 articles) 3 that met the inclusion criteria [27][28][29][30][31][32][33][34]. The three main reasons for exclusion of the other 26 articles were: (1) that the study did not evaluate an intervention (n = 6), (2) the target population of the intervention included other HCWs in addition to nurses and did not allow for separate analysis (n = 17), or (3) the methodological quality assessment score was below three (n = 3).…”

“…Fox et al 2015 [30] Erasmus et al 2010 [27] Stock et al 2015 [28] Harne-Britner et al 2011 [29] Huis et al 2012 [31,32,35] Boyce et al 2019 [33] Stella et al 2019 [34] Characteristics of the included studies are presented in Table 3.…”

“…Stella et al (2019) [34] studied the effect of two visual cues on HHC in a prospective, quasi-experimental study that utilised an interrupted time-series design. Intervention placards that depicted an image of eyes, a social norms message, or a control placard (image of mountains) were placed near soap and ABHR dispensers and alternated every 10 days.…”

User-centred participatory design of visual cues for isolation precautions

“…Such studies have found that the presence of eye images act as a subtle cue and that people paid as much as three times more often for their drinks when human eyes were displayed, as opposed to when a neutral control image was displayed [27]. Studies in infection prevention settings, however, have had mixed success in reproducing this effect [28–30]. Further studies on this topic are warranted to better understand how signage may be employed to prime cooperative behaviour and thus improve guideline adherence.…”

Emojis in public health and how they might be used for hand hygiene and infection prevention and control

“…Education entertainment provided by social media is a promising method to promote individual behavior change such as hand hygiene [43], and emojis are helpful tools to add topics and ideas by facilitating a more natural communication [6]. According to the literature, visual stimuli have been found effective to use in lectures and written texts in order to improve hand hygiene behavior and it has also been suggested that animated visual elements may have a better and more direct effect compared with static pictures [44][45][46]. Likewise, emotional events are memorized more precisely and for a longer duration compared with neutral events, making them beneficial aspects to consider in education and memory [47].…”