• Intern Emerg Med · Oct 2022

    A nudge intervention to improve hand hygiene compliance in the hospital.

    • Fabrizio Elia, Fabrizio Calzavarini, Paola Bianco, Renata Gabriella Vecchietti, Antonio Franco Macor, Alessia D'Orazio, Antonella Dragonetti, Alessandra D'Alfonso, Laura Belletrutti, Mara Floris, Fabrizio Bert, Vincenzo Crupi, and Franco Aprà.
    • Emergency Medicine, San Giovanni Bosco Hospital, Turin, Italy. fa.elia@libero.it.
    • Intern Emerg Med. 2022 Oct 1; 17 (7): 189919051899-1905.

    AbstractHand hygiene among professionals plays a crucial role in preventing healthcare-associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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