Using environmental engineering to increase hand hygiene compliance: a cross-over study protocol

Research output: Contribution to journalArticle

  • External authors:
  • Kelley Anne Schmidtke (Lead)
  • Navneet Aujla
  • Tom Marshall
  • Abid Hussain
  • Kristopher Arheart
  • Joachim Marti
  • David J Birnbach
  • Ivo Vlaev


Introduction: Compliance with hand hygiene
recommendations in hospital is typically less than 50%.
Such low compliance inevitably contributes to hospital acquired
infections that negatively affect patients’ wellbeing
and hospitals’ finances. The design of the present
study is predicated on the assumption that most people
who fail to clean their hands are not doing so intentionally,
they just forget. The present study will test whether
psychological priming can be used to increase the number
of people who clean their hands on entering a ward. Here,
we present the protocol for this study.

Methods and analysis: The study will use a randomised
cross-over design. During the study, each of four wards
will be observed during four conditions: olfactory prime,
visual prime, both primes and neither prime. Each
condition will be experienced for 42 days followed by
a 7-day washout period (total duration of trial=189
days). We will record the number of people who enter
each ward and whether they clean their hands during
observation sessions, the amount of cleaning material
used from the dispensers each week and the number of
hospital-acquired infections that occur in each period. The
outcomes will be compared using a regression analysis.
Following the initial trail, the most effective priming
condition will be rolled out for 3 months in all the wards.

Ethics and dissemination: Research ethics approval
was obtained from the South Central—Oxford C Research
Ethics Committee (16/SC/0554), the Health Regulatory
Authority and the sponsor.

Trial registration number ISRCTN (15397624); Edge ID

Bibliographical metadata

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalBMJ Open
Issue number9
Publication statusPublished - 1 Sep 2017