Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Medical Microbiology & Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
J Hosp Infect. 2018 Apr;98(4):352-358. doi: 10.1016/j.jhin.2017.09.023. Epub 2017 Sep 30.
Hand hygiene is paramount to prevent healthcare-associated infections, but improving compliance is challenging. When healthcare workers seldom encounter healthcare-associated infections, they will consider the odds of causing infections through poor hand hygiene negligible. Cognitive biases such as these may induce non-compliance. Nudging, 'a friendly push to encourage desired behaviour', could provide an easily implemented, inexpensive measure to address cognitive biases and thus support hand hygiene interventions.
To investigate whether behavioural nudges, displayed as posters, can increase the use of alcohol-based hand rub.
We developed nudges based on a systematic review of previously described cognitive biases, and tested these through a cross-sectional survey among the target audience. We then conducted a controlled before-after trial on two hospital wards, to assess the effect of these nudges on the use of alcohol-based hand rub, measured with electronic dispensers.
Poisson regression analyses adjusted for workload showed that nudges displayed next to dispensers increased their overall use on one ward [poster 1: relative risk: 1.6 (95% confidence interval: 1.2-2.2); poster 2: 1.7 (1.2-2.5)] and during doctor's rounds on both wards [poster 1: ward A: 1.7 (1.1-2.6); ward B: 2.2 (1.3-3.8)]. Use of dispensers without adjacent nudges did not increase.
Nudges based on cognitive biases that play a role in hand hygiene, and displayed as posters, could provide an easy, inexpensive measure to increase use of alcohol-based hand rub. When applying nudges to change behaviour, it is important to identify the right nudge for the right audience.
手部卫生对于预防医源性感染至关重要，但提高依从性具有挑战性。当医护人员很少遇到医源性感染时，他们会认为因手部卫生不佳而导致感染的可能性微乎其微。这种认知偏差可能导致不遵守规定。“助推”（通过友好的推动鼓励期望的行为）是一种简单易行且经济实惠的措施，可以解决认知偏差问题，从而支持手部卫生干预措施。
研究行为助推（以海报形式呈现）是否可以增加酒精擦手液的使用。
我们根据先前描述的认知偏差的系统评价制定了助推措施，并通过目标受众的横断面调查对其进行了测试。然后，我们在两个病房进行了对照前后试验，使用电子分配器来评估这些助推措施对酒精擦手液使用的影响。
调整工作量后的泊松回归分析表明，分配器旁边展示的海报可以增加其中一个病房的总体使用量[海报 1：相对风险：1.6（95%置信区间：1.2-2.2）；海报 2：1.7（1.2-2.5）]，并且可以增加两个病房在医生查房期间的使用量[海报 1：病房 A：1.7（1.1-2.6）；病房 B：2.2（1.3-3.8）]。没有相邻海报的分配器的使用量没有增加。
基于在手部卫生中起作用的认知偏差的助推措施，并以海报形式呈现，可以提供一种简单、经济实惠的措施来增加酒精擦手液的使用。在应用助推措施来改变行为时，重要的是要为正确的受众选择正确的助推措施。
