Blair Calea-Jay, McCrudden Clare, Brazier Alix, Huf Sarah, Gregory Alice, O'Driscoll Fiona, Galletly Tracey, Leon-Villapalos Clare, Brown Helen, Clay Kristina, Maxwell Shona, Anakwe Raymond, Grailey Kate
Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
Helix Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
PLoS One. 2024 Dec 12;19(12):e0310768. doi: 10.1371/journal.pone.0310768. eCollection 2024.
Compliance with hand hygiene is an effective way of reducing the incidence of healthcare acquired infections (HCAI). At one London National Health Service (NHS) Trust, improving hand hygiene compliance (HHC) was a patient safety priority in response to non-compliance and ongoing occurrences of HCAI. The objective of this study was to co-design a behavioural science informed intervention to improve HHC. To obtain a baseline level of HHC and understand associated behaviours, 18 hours of observation were undertaken on three inpatient wards. These focused upon Moment 1 and 5 of the World Health Organisation's moments for hand hygiene. The intervention was co-designed with clinical staff and took the form of "visual primes". Three different stickers designed to create a motivational "nudge" were placed at key points where HHC had been observed to fail. Following implementation, a further 18 hours of observation took place. A Chi-squared statistical analysis compared proportions of HHC pre- and post-intervention. Our intervention led to an 11% increase in HHC across the three study wards for both Moments (X2 (1, N = 1,285) = 13.711, p = <0.001) in the six weeks following the intervention. The intervention had a more marked effect on Moment 1, (with an increase of 15%, X2 (1, N = 667) = 17.091, p = <0.001 when compared to the change in compliance with Moment 5 (11%, X2 (1, N = 652) = 7.449, p = 0.06). This study demonstrated that utilising behavioural science in the co-design and placement of visual motivational nudges can significantly improve compliance with hand hygiene practices. We highlight the benefit of co-design when designing interventions-both in terms of engagement with and efficacy of the intervention.
遵守手部卫生是降低医疗保健相关感染（HCAI）发生率的有效方法。在伦敦的一家国民保健服务（NHS）信托机构中，鉴于手部卫生合规性（HHC）不达标以及HCAI持续发生的情况，提高手部卫生合规性成为患者安全的首要任务。本研究的目的是共同设计一种基于行为科学的干预措施，以提高手部卫生合规性。为了获得手部卫生合规性的基线水平并了解相关行为，在三个住院病房进行了18小时的观察。观察重点是世界卫生组织手部卫生时刻中的时刻1和时刻5。该干预措施是与临床工作人员共同设计的，采取了“视觉提示”的形式。设计了三种不同的贴纸，旨在产生激励性的“推动”作用，并贴在观察到手部卫生合规性不达标的关键点上。实施干预措施后，又进行了18小时的观察。采用卡方统计分析比较干预前后手部卫生合规性的比例。在干预后的六周内，我们的干预措施使三个研究病房在这两个时刻的手部卫生合规性均提高了11%（X2（1，N = 1285）= 13.711，p = <0.001）。该干预措施对时刻1的影响更为显著（提高了15%，与时刻5的合规性变化（11%，X2（1，N = 652）= 7.449，p = 0.06）相比，X2（1，N = 667）= 17.091，p = <0.001）。本研究表明，在共同设计和放置视觉激励性推动措施时运用行为科学可以显著提高手部卫生规范的遵守情况。我们强调了在设计干预措施时共同设计的益处——无论是在干预措施的参与度还是有效性方面。
