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Emoticons support hand hygiene in hospitals

Study shows: Emoticons promote hand hygiene in hospitals

ingo-man® plus disinfectant dispenser part of a scientific study at the Rottal-Inn clinics.

Hospital Acquired Infections (HAI’s) are a growing global concern and a burden on healthcare systems worldwide. In Europe alone, 2.6 million HAI’s occur each year and in about 80 percent of all cases, the hands are the main transmission path of germs.

Particularly in medical facilities, careful hand disinfection by hospital staff is considered a “safety belt” for the patient, as it is not uncommon for those treated to suffer from immunodeficiency. Despite efforts to increase awareness of the importance of proper hand hygiene, everyday practice still falls short of ideal compliance. There are many missed opportunities in medical facilities for proper hand hygiene as compliance rates slowly climb. Increased work load and lack of available disinfectants are some of the main challenges that face proper hand disinfection within medical facilities.

Psychological factor: part of a whole

Multimodal interventions have proven to be an effective method of sustainably improving hand hygiene behaviour. Isolated individual measures often fail because they only increase compliance in the short term and have no positive long-term effects. Easy access to hand disinfectant dispensers, needs-based training, and the involvement of hand hygiene managers are important components of the multimodal approach, however, they alone are not always adequate.

Electronic monitoring systems enable those responsible for hygiene to report their hygiene behaviour back to doctors and nursing staff in a timely manner. The psychological component to hygiene is playing an increasingly important role, and with hand hygiene data available at the push of a button, it is becoming easier to improve compliance rates in health care environments.

Smileys for infection protection

Better understanding behavioral changes for hand disinfection in every day clinical practice aided by learning more about user interactions with visual cues. A research team from the University of Regensburg, the Technical University of Munich and the University College London took this opportunity to investigate the influence of emoticons on hand hygiene behaviour.

In the surgical ward of the Rottal-Inn Kliniken in Eggenfelden, Bavaria, eight out of sixteen patient rooms were selected for the installation of screens that provide visual feedback after hand disinfection. The screens were installed in the immediate vicinity and above the hand disinfectant dispensers. Manual ingo-man® plus disinfectant dispensers were used, which recorded every lever movement and were connected to the screens or motion sensors above the hygiene dispenser. The study was divided into a baseline and an intervention phase.

In the baseline phase, the number of hand disinfections was measured over eight weeks without intervention or feedback on the screen.  The subsequent intervention phase lasted nine weeks and was divided into a total of four scenarios: In each of the eight patient rooms, screens showed a specific emoticon when performing or refraining from hand disinfection. For example, laughing and sad smiley were used in patient rooms 1 and 2. In the other patient rooms, flowers and eyes were used as control condition.

The results were that the number of hand disinfections in the two patient rooms with smileys increased significantly compared to the baseline phase.

Implementation in everyday practice

What can we learn from the results? The visual feedback with emoticons for hand hygiene behaviour can be used as a meaningful measure to increase hand hygiene compliance in everyday hospital life.

Compliance for hand hygiene plays a very important role in patient protection, especially in hygiene-sensitive areas. Combined with organizational and personnel factors, the psychological factor offers great potential for improving patient protection in hospitals.

Source: Gaube, Susanne, et al. “How a smiley protects health: A pilot intervention to improve hand hygiene in hospitals by activating injunctive norms through emoticons”. PloS one 13.5 (2018): e0197465.


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