Nudging hospital staff to prioritise hand-hygiene compliance: antibacterial gel or hand washing over over-use of gloves; using visual priming
What unsustainable behavior needs to change:
Changes in hospital practice due to COVID-19 led to new ways of working, particularly with respect to personal protective equipment and hand hygiene. Notably the use of gloves became the (most frequented) method during the pandemic. As the world returns to a new “normal” post-pandemic, there has been a shift to return to typical pre-pandemic infection control practices, with less emphasis on glove use and more on standardised hand washing and alcohol gel use.
However, it has been observed that the previous guidelines during the height of COVID-19 are still being adhered to in audits, demonstrating an overuse of gloves. In a study conducted by the Change Lab researchers, it was identified that one of the main failures in hand hygiene compliance was the use of gloves as an alternative to hand hygiene compliance (HHC); rather than not washing/gelling hands before or after patient contact.
The Green Nudge:
Because of this the Change Lab study team hosted co-design sessions with ward staff and infection control teams. They wanted to design and develop nudges encouraging hospital staff to return to basics of hand hygiene compliance: using alcohol gels and standardised hand washing; with one of the nudges focusing on the negative environmental impact of glove overuse.
The green nudge was a co-designed sticker, a visual prime placed on the glove dispenser boxes to prompt hand hygiene compliance and minimise overuse of gloves, where appropriate. The green nudge reads “Under the sea is where gloves will be… so if you can, wash your hands instead” with an image of a turtle to represent the environment.
The result: Post-intervention, there was a statistically significant increase of 11% in HHC post-intervention. As was evident, this green nudge was a key part of a co-designed, behaviourally informed visual prime intervention effective at increasing the level of HHC at the Change Lab study site. The research team is currently scaling the 3 nudges across more hospital sites and looking at ways to contribute to the NHS Trust’s Green Plan.
Are you aware of any other nudges that help to prevent waste? Feel free to get in touch: hello@green-nudges.com
From healthcare expert Clare McCrudden. In order to develop effective nudges for improving hand hygiene compliance, she was part of a team of behavioural scientists at Imperial College London’s Institute of Global Health Innovation, known as Change Lab. They were tasked by a large NHS Trust in London to co-design nudges with hospital ward staff and infection control colleagues to enhance hand hygiene compliance.
Images or objects in busy public urinals reduce splash and water waste, cutting cleaning needs in high-traffic areas.