In the Journals

Placards do not improve hand hygiene adherence

Sarah A. Stella, MD
Sarah A. Stella

Hand hygiene placards posted in a Denver hospital — including one that featured an image of two eyes looking directly at the viewer with a reminder to clean their hands — did not result in measurable improvements in hand hygiene adherence among health care workers, researchers reported.

“Hospitals around the country are struggling to address hand hygiene adherence, but there are no nationally adopted standards for hand hygiene measurement and improvement, and an optimal combination of elements in hand hygiene ‘bundles’ remains unclear,” Sarah A. Stella, MD, associate professor of medicine and hospital medicine at the University of Colorado School of Medicine, told Infectious Disease News. “Infection preventionists often utilize visual cues and reminders in an attempt to influence behavior without evidence that they are effective.”

Stella and colleagues conducted their prospective, quasiexperimental study in two units at Denver Health Medical Center from Oct. 11, 2016, to Feb. 8, 2017. The first experiment used a placard with the message “clean hands on entry and exit,” accompanied by either an image of eyes or a control image of mountains. The second used a placard with a message encouraging compliance with social norms — “The majority of healthcare providers on this floor clean their hands” — that was accompanied by either an image of health care providers or a control image of mountains. (Intervention placards can be seen here and here.)

The intervention and control placards were placed near soap and alcohol-based hand-rub dispensers in the two participating units and were alternated every 10 days during each experiment. Both experiments had six periods — three intervention periods and three control periods.

The researchers electronically monitored 166 nurses and certified nursing assistants and collected 184,172 electronic observations. According to the study, the median number of electronic observations was 1,471.

The preintervention baseline hand hygiene adherence rate was 70%, Stella and colleagues reported. For both interventions, they did not observe any statistically significant increases in hand hygiene adherence.

“Understanding what does not work is as important as knowing what does work,” Stella said. “Thus, our study is a valuable contribution to the small number of well-designed studies exploring interventions to improve hand hygiene adherence in the hospital setting. More research should focus on which combination of elements is effective and the dose and boundary conditions affecting these interventions.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

Sarah A. Stella, MD
Sarah A. Stella

Hand hygiene placards posted in a Denver hospital — including one that featured an image of two eyes looking directly at the viewer with a reminder to clean their hands — did not result in measurable improvements in hand hygiene adherence among health care workers, researchers reported.

“Hospitals around the country are struggling to address hand hygiene adherence, but there are no nationally adopted standards for hand hygiene measurement and improvement, and an optimal combination of elements in hand hygiene ‘bundles’ remains unclear,” Sarah A. Stella, MD, associate professor of medicine and hospital medicine at the University of Colorado School of Medicine, told Infectious Disease News. “Infection preventionists often utilize visual cues and reminders in an attempt to influence behavior without evidence that they are effective.”

Stella and colleagues conducted their prospective, quasiexperimental study in two units at Denver Health Medical Center from Oct. 11, 2016, to Feb. 8, 2017. The first experiment used a placard with the message “clean hands on entry and exit,” accompanied by either an image of eyes or a control image of mountains. The second used a placard with a message encouraging compliance with social norms — “The majority of healthcare providers on this floor clean their hands” — that was accompanied by either an image of health care providers or a control image of mountains. (Intervention placards can be seen here and here.)

The intervention and control placards were placed near soap and alcohol-based hand-rub dispensers in the two participating units and were alternated every 10 days during each experiment. Both experiments had six periods — three intervention periods and three control periods.

The researchers electronically monitored 166 nurses and certified nursing assistants and collected 184,172 electronic observations. According to the study, the median number of electronic observations was 1,471.

The preintervention baseline hand hygiene adherence rate was 70%, Stella and colleagues reported. For both interventions, they did not observe any statistically significant increases in hand hygiene adherence.

“Understanding what does not work is as important as knowing what does work,” Stella said. “Thus, our study is a valuable contribution to the small number of well-designed studies exploring interventions to improve hand hygiene adherence in the hospital setting. More research should focus on which combination of elements is effective and the dose and boundary conditions affecting these interventions.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.