A sign of change for hand hygiene

If you want to boost hand hygiene, the right sign can help. Health care workers are more likely to wash up out of concern for patient safety, researchers report.

In a study slated for publication in an upcoming issue of Psychological Science, organizational behavioralists at the University of North Carolina in Chapel Hill hung different signs above alcohol gel dispensers and measured the frequency of hand hygiene.

One sign said, "Hand hygiene prevents you from catching diseases." Another said, "Hand hygiene prevents patients from catching diseases." A neutral sign said simply, "Gel in, wash out."

Changing one word — and prodding health care workers to protect patients — led to a 33% improvement in hand hygiene, says co-author David Hofmann, PhD, professor of organizational behavior at the university's Kenan-Flagler Business School.

The sign speaks to the core imperative in medicine — "First do no harm," says Hofmann. It also sidesteps another common perception, he says. Health care workers often think they have a better immunity and don't get sick, he says.

"It's difficult for them to think about an instance when they didn't wash hands and that led them to get sick," he says. "There are factors that would lead them to be overconfident."

Simply putting up a new sign won't solve the problem of hand hygiene compliance, Hofmann notes.

"Encouraging and improving hand hygiene is a complex problem to solve, as has been well shown in health care," he says. "We don't expect, and our results don't demonstrate, that if you change to patient-focused signs the problem will miraculously go away.

"We do find that changing to a patient-focused sign does have a significant effect on hand hygiene," he says. "For an organization trying to address this problem, this could be one aspect of that systematic approach."

So while you're working on improving hand hygiene, consider putting some new signs above your dispensers.

"I would encourage hospitals to think about using this as one of a number of different levers they pull to try to address the hand hygiene problem," Hofmann says.