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Reinoso Schiller N, Bludau A, Mathes T, König A, von Landesberger T, Scheithauer S. Unpacking nudge sensu lato: insights from a scoping review. J Hosp Infect 2024; 143:168-177. [PMID: 37949370 DOI: 10.1016/j.jhin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Nudges may play an important role in improving infection prevention and control (IPC) in hospitals. However, despite the novelty of the framework, their objectives, strategies and implementation approaches are not new. This review aims to provide an overview of the methods typically used by nudge interventions in IPC in hospitals targeting healthcare workers (HCWs). The initial search in PubMed yielded nine hits. Consequently, the search criteria were broadened and a second search was conducted, introducing 'nudge sensu lato' which incorporates insights from sources beyond the traditional nudge framework while maintaining the same objectives, strategies and approaches. During the second search, PubMed, Epistemonikos, Web of Science and PsycInfo were searched in accordance with the PRISMA guidelines. Abstracts were screened, and reviewers from an interdisciplinary team read the full text of selected papers. In total, 5706 unique primary studies were identified. Of these, 67 were included in the review, and only four were listed as nudge sensu stricto, focusing on changing HCWs' hand hygiene. All articles reported positive intervention outcomes. Of the 56 articles focused on improving hand hygiene compliance, 71.4% had positive outcomes. For healthcare equipment disinfection, 50% of studies showed significant results. Guideline adherence interventions had a 66.7% significant outcome rate. The concept of nudge sensu lato was introduced, encompassing interventions that employ strategies, methods and implementation approaches found in the nudge framework. The findings demonstrate that this concept can enhance the scientific development of more impactful nudges. This may help clinicians, researchers and policy makers to develop and implement effective nudging interventions.
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Affiliation(s)
- N Reinoso Schiller
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany.
| | - A Bludau
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - T Mathes
- Department of Medical Statistics, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - A König
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - T von Landesberger
- Chair for Visualization and Visual Analytics, University of Cologne, Cologne, Germany
| | - S Scheithauer
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
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Lin W, Li Z, Zhang X, Gao Y, Lin J. Electrophysiological evidence for the effectiveness of images versus text in warnings. Sci Rep 2023; 13:1278. [PMID: 36690718 PMCID: PMC9870998 DOI: 10.1038/s41598-023-28230-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
Warning sign plays an important role in risk avoidance. Many studies have found that images are better warnings than text, while others have revealed flaws of image-only warning signs. To better understand the factors underlying the effectiveness of different types of warning signs (image only, text only, or image and text), this study adopted event-related potential technology to explore the differences at the neurocognitive level using the oddball paradigm and the Go/No-go paradigm. Together, the behavioral and electroencephalogram results showed that text-only warnings had the lowest effectiveness, but there was little difference between the image-only and image-and-text warnings. The differences in the effects of the three warning signs were mainly in the areas of attention and cognitive control, implying differences in the underlying cognitive processes. Therefore, in the design of warning signs, the effects of different design attributes on cognitive processing should be taken into account based on actual needs in order to improve the effectiveness of the signs.
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Affiliation(s)
- Wuji Lin
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, Sichuan, China
| | - Zhuoyu Li
- Mental Health Education and Counseling Center, Guangdong Teachers College of Foreign Language and Arts, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
| | - Xukai Zhang
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Yuan Gao
- School of Psychology, South China Normal University, Guangzhou, China
| | - Jingyuan Lin
- School of Psychology, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen City, China.
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Lotfinejad N, Tartari E, Sauser J, Fankhauser-Rodriguez C, Pires D, Pittet D. Are emojis ready to promote the WHO 5 moments for hand hygiene in healthcare? Antimicrob Resist Infect Control 2022; 11:127. [PMID: 36289506 PMCID: PMC9607812 DOI: 10.1186/s13756-022-01164-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Background Hand hygiene is universally recognized as a cornerstone measure for the prevention of healthcare-associated infections. Although the WHO “My five Moments for hand hygiene” poster has been used for more than a decade to delineate hand hygiene indications and promote action, adherence levels among healthcare workers are still notoriously low and disquieting. To compensate for the lack of effective hand hygiene communication, we aimed to evaluate emojis as possible surrogates for the non-verbal aspects of hand hygiene behaviour. Methods Following a thorough review of the Unicode version 12.0, the most applicable emojis to the terms used in the WHO 5 Moments poster were extracted. We developed a self-administered questionnaire to assess the view of infection prevention and control (IPC) practitioners regarding the use of emojis to show the WHO 5 Moments. Completed questionnaires were collected and analysed to determine the suitability of the existing emojis to illustrate a unified emoji poster. Data were analysed using R (version 3.6.3). Results A total of 95 IPC practitioners completed the questionnaire from May to October 2019 from different countries. Of these, 69 (74%) were female, and the mean age of the participants was 44.6 ± 10.87 years. We found appropriate emojis for six of the words used in the poster, including
for touching (72%),
for patient (63%),
for clean (53%),
for procedure (56%),
for body fluid (58%), and
for exposure risk (71%). The existing emojis proposed for the words “hygiene”, “aseptic”, and “surrounding” seemed to be less satisfactory. Conclusions In summary, the findings of this study indicate that the existing emojis may not be able to substitute the words used in the WHO 5 Moments poster. Emojis might be helpful to address hand hygiene indications in healthcare that may eventually play a role in promoting this measure. However, emojis should be further studied to choose the most appropriate ones and avoid ambiguity and misinterpretation. More emojis to convey health related messages are needed. We recommend further research in this area to evaluate the effect of using emojis in healthcare-related behaviours. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01164-1.
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Affiliation(s)
- Nasim Lotfinejad
- grid.150338.c0000 0001 0721 9812Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Infection Control Programme, WHO Collaborating Centre on Infection Prevention and Control & Antimicrobial Resistance, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ermira Tartari
- grid.150338.c0000 0001 0721 9812Infection Control Programme, WHO Collaborating Centre on Infection Prevention and Control & Antimicrobial Resistance, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland ,grid.4462.40000 0001 2176 9482Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Julien Sauser
- grid.150338.c0000 0001 0721 9812Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Infection Control Programme, WHO Collaborating Centre on Infection Prevention and Control & Antimicrobial Resistance, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Carolina Fankhauser-Rodriguez
- grid.150338.c0000 0001 0721 9812Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Infection Control Programme, WHO Collaborating Centre on Infection Prevention and Control & Antimicrobial Resistance, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Daniela Pires
- grid.150338.c0000 0001 0721 9812Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Didier Pittet
- grid.150338.c0000 0001 0721 9812Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Infection Control Programme, WHO Collaborating Centre on Infection Prevention and Control & Antimicrobial Resistance, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Eng TY, Eng NL, Jenkins CA, Grota PG. "Did you wash your hands?": a prospective study of patient empowerment to prompt hand washing by healthcare providers. J Infect Prev 2021; 22:195-202. [PMID: 34659457 DOI: 10.1177/17571774211012767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hand hygiene is paramount in preventing the spread of healthcare-associated infections especially during disease epidemics. Compliance rates with hand hygiene policies remain below 50% internationally and may be lower in the outpatient care setting. This study assessed the impact of the patient empowerment model on hand hygiene compliance among healthcare providers. Methods From October 2016 to May 2017, patients from a large ambulatory oncology centre were prospectively enrolled. Patients were instructed to observe healthcare providers for hand hygiene compliance and to remind healthcare providers where it was not observed during at least three consecutive encounters. Healthcare provider reactions to this intervention were rated by patients. Patients' hand hygiene knowledge and beliefs were objectively elicited pre and post-study. Results Thirty patients with a median age of 52 years (range 5-91) completed the study for a total of 190 healthcare provider encounters. When initial hand hygiene was not observed, patients offered a reminder in 71 (37.4%) encounters, did not offer a reminder in 73 (38.4%) encounters and forgot to offer a reminder in 24 (14.2%) encounters. Patients perceived positive or neutral reactions in 76.8% of encounters and negative or surprised reactions in 23.2% of encounters. Healthcare provider compliance improved from 11.6% to 48.9% with intervention. Patient hand hygiene knowledge improved by 16% following the study. Conclusions Patient-empowered hand hygiene may be a useful adjunct for improving hand hygiene compliance among healthcare providers and improving patient hand hygiene knowledge, although it may confer an emotional burden on patients.
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Affiliation(s)
- Tony Y Eng
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - Nina L Eng
- School of Medicine, Emory University, Atlanta, USA
| | - Carol A Jenkins
- Department of Radiation Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, USA
| | - Patti G Grota
- Office of Faculty Excellence, School of Nursing, UT Health San Antonio, San Antonio, USA
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Three-year hand hygiene monitoring and impact of real-time reminders on compliance. J Hosp Infect 2021; 117:111-116. [PMID: 34428506 DOI: 10.1016/j.jhin.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/12/2021] [Accepted: 08/16/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hand hygiene remains both the major strategy and an ongoing challenge for infection control. The main issues in the sustainability of hand hygiene automatic monitoring are healthcare worker (HCW) turnover rates and declining participation. AIM To assess hand hygiene compliance and the impact of real-time reminders over three years. METHODS HCW compliance was observed for the use of alcohol-based hand rubs (AHR) on room entry and exit. Linear multi-level mixed models with time autocorrelations were performed to analyse the repeated measurements of daily room compliance and the effect of reminders over eight quarters (24 months). FINDINGS In all, 111 HCWs were observed and 525,576 activities were identified in the database. There was an improvement in compliance both on room entry and exit over two years, and the rooms which had activated reminders had better performance than the rooms which did not have activated reminders. CONCLUSIONS This study showed the benefit of using real-time reminders; even 20% of rooms with an activated reminder improved overall hand hygiene compliance. A randomized real-time reminder setting may be a potential solution in reducing user fatigue and enhancing HCW self-awareness.
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Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. THE LANCET. INFECTIOUS DISEASES 2021; 21:e209-e221. [PMID: 34331890 DOI: 10.1016/s1473-3099(21)00383-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022]
Abstract
Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.
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Affiliation(s)
- Nasim Lotfinejad
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alexandra Peters
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ermira Tartari
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Malta
| | | | - Daniela Pires
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect 2021; 111:6-26. [PMID: 33744382 PMCID: PMC9585124 DOI: 10.1016/j.jhin.2021.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Background There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. Aim This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene. Methods CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. Findings Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the ‘Five Moments’. However, recording of hand hygiene technique was not common. Conclusion Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.
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Beyond personal protective equipment: adjunctive methods for control of healthcare-associated respiratory viral infections. Curr Opin Infect Dis 2020; 33:312-318. [PMID: 32657968 DOI: 10.1097/qco.0000000000000655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Prevention of nosocomial transmission of respiratory viruses is a priority in all healthcare settings and often achieved with the use of personal protective equipment. Several adjunctive infection prevention methods are in common use but their effectiveness in reducing healthcare-associated respiratory viral infections is unclear. In this review, recent advances regarding the effectiveness of several adjunctive infection prevention methods to reduce healthcare-associated respiratory viral infections are discussed. RECENT FINDINGS Training and education on hand hygiene guidelines, mandatory influenza vaccination for healthcare personnel, access to paid sick leave to reduce ill presenteeism, cohorting of patients with the same infection or clinical syndrome, neuraminidase inhibitor chemoprophylaxis during influenza outbreaks, and enhanced visitor restrictions in pediatric hospitals all have shown some degree of effectiveness in observational or quasi-experimental studies. SUMMARY Most of the studies evaluating the effect of adjunctive infection prevention methods on healthcare-associated respiratory viral infections are observational or quasi-experimental and are often combined with other interventions. Therefore, it is difficult to determine the precise effectiveness or efficacy of these interventions and more controlled trials are needed. Multimodal infection prevention policies are likely to be most effective in reducing healthcare-associated respiratory viral infections.
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Goedken CC, Livorsi DJ, Sauder M, Vander Weg MW, Chasco EE, Chang NC, Perencevich E, Reisinger HS. "The role as a champion is to not only monitor but to speak out and to educate": the contradictory roles of hand hygiene champions. Implement Sci 2019; 14:110. [PMID: 31870453 PMCID: PMC6929350 DOI: 10.1186/s13012-019-0943-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Implementation science experts define champions as "supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization." Many hospitals use designated clinical champions-often called "hand hygiene (HH) champions"-typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term "HH champion" and how they define the role. METHODS An ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes. RESULTS A total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role. CONCLUSIONS Healthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance-and differentiate it from the role of a "compliance auditor." Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.
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Affiliation(s)
- Cassie Cunningham Goedken
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
| | - Daniel J. Livorsi
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
| | - Michael Sauder
- Department of Sociology, University of Iowa, 140 Seashore Hall West, Iowa City, IA 52242 USA
| | - Mark W. Vander Weg
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
- Department of Psychological and Brain Sciences, University of Iowa, W311 Seashore Hall, Iowa City, IA 52242-1407 USA
| | - Emily E. Chasco
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
| | - Nai-Chung Chang
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132 USA
| | - Eli Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
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