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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Signs: Can one word make a difference?

With historical hand hygiene compliance rates typically in the 50% range, infection preventionists have tried multiple interventions that include a vast array of signs and messages in an attempt to change the behavior of health care workers. Can one word make a difference?

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.

A neutral sign said simply, “Gel in, wash out.” Another sign said, “Hand hygiene prevents you from catching diseases.” The clear winner was: “Hand hygiene prevents patients from catching diseases.”

Changing one word – “you” to “patients” – led to a 33% improvement in hand hygiene, says co-author David Hofmann, PhD, professor of organizational behavior at the university.

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 good immunity and will not 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.”

Of course, 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.”