Dr. Eleanor Barbera

As a consultant in long-term care, I learned how to properly wash my hands by reading the hand hygiene poster hung above the sink at one of my first nursing homes.

I’ve gotten more diligent over the years (read: paranoid), making an effort to sanitize my hands as I move from room to room, but I wonder about those whose roles in long-term care don’t specifically emphasize infection control procedures.

While infection control is an integral part of training for most staff members, there are many other people in facilities — visitors, volunteers, vendors and residents, among others — who might not fully recognize the importance of hand washing to prevent the spread of infection.

In fact, a recent study suggests that even those who should know better don’t wash their hands as often as they should. Researchers found that doctors in a California hospital had a hand hygiene compliance rate of about 22% when they didn’t realize they were being observed and a rate of 57% when they recognized that the infection control staff was watching them.

The research paper is titled, “Hawthorne Effect in Hand Hygiene Compliance Rates,” referring to the change in behavior due to being observed. To me, however, the takeaway is that hand hygiene compliance rates range from being abysmal to mediocre. Clearly, this is an area that needs more attention.

A study presented at this month’s Association for Professionals in Infection Control and Epidemiology conference suggests a novel method of increasing hand-washing compliance.

Because prior research had found success in appealing to emotional motivators such as disgust in changing hand-washing behavior, investigators exposed subjects to unappealing photos of bacterial contamination. This visual exposure helped participants imagine the contamination on their own hands and increased their likelihood of hand washing by 11% to 46%.

We could call it the “Eww, Gross! Method.”

Other techniques suggested by infection control and other researchers to increase hand hygiene compliance are below:

•  Publishing (in-house) rates of hand-washing observance for each unit to create a healthy sense of competition. The best team could be rewarded, perhaps with pizza or a special lotion to soothe frequently cleansed hands.

•  Use peer pressure with signs indicating that, “everyone else is doing it.” The message could say, for example, “Join your coworkers in preventing the spread of infection through hand washing.”

• Take peer pressure a step further by sending messages in paychecks for those with low compliance that read, “You are one of the few who aren’t consistently washing their hands.” Yikes! That’s certainly a call to action! (The British government successfully used a version of this “nudge principle” to collect an additional $15 million from citizens who were delinquent on their taxes after they were sent notes saying they were “one of the few who have not paid us yet.”)

•  If the above suggestion is too Orwellian for your team, try using a variety of pleasantly scented sanitizing lotions or hand soaps so that it’s enjoyable to smell what comes out of the dispenser and fun to try new scents.

•  Employ regular checks to be sure your housekeeping staff is keeping dispensers filled and have “Plan B” sanitizers available for times when they aren’t, such as sanitizing products by the nursing station.

•  Empower residents to remind staff members to wash their hands. Have a community-wide “point it out” campaign so that staff members expect residents to be aware and to speak up. Teach residents how to encourage compliance with humor and grace.

•  Post hand hygiene signs in the lobby near sanitizing dispensers and include related tips in newsletters for families. Use the emotional motivator of nurture to encourage them to take care of their loved ones through proper hand washing.

•  Make hand hygiene a part of your staff recognition program by acknowledging workers for prioritizing this aspect of infection control.

A combination of these techniques is likely to result in a culture of hand hygiene compliance — and that’s something for which we can clap our clean hands.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.