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Health services research
Protocol
Using environmental engineering to increase hand hygiene compliance: a cross-over study protocol
  1. Kelly Ann Schmidtke1,
  2. Navneet Aujla1,
  3. Tom Marshall1,2,
  4. Abid Hussain3,
  5. Gerard P Hodgkinson4,
  6. Kristopher Arheart5,
  7. Joachim Marti6,
  8. David J Birnbach7,
  9. Ivo Vlaev1
  1. 1Behavioural Science Group, Warwick Business School, The University of Warwick, Coventry, UK
  2. 2Primary Care Clinical Sciences Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  3. 3Infection Prevention and Control, Heart of England NHS Foundation Trust, Birmingham, UK
  4. 4Alliance Manchester Business School, The University of Manchester, Manchester, UK
  5. 5Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida, USA
  6. 6Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
  7. 7Department of Anesthesiology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Kelly Ann Schmidtke; Kelly.Schmidtke{at}wbs.ac.uk

Abstract

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’ well-being 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 86357.

  • Priming
  • Environmental Engineering
  • Hand-Hygiene
  • Hospital Acquired Infections.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-017108

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    Footnotes

    • Contributors The protocol was collaboratively developed by all coauthors. KAS wrote the protocol with coordinated input from all collaborators. Notably, NA and GPH substantially contributed to the redrafting of the manuscript. KA largely wrote the sample size section along with the statistical analyses for objectives 1–4. JM largely wrote the statistical analyses for objective 5.

    • Funding Environmental engineering to increase hand hygiene compliance is part of the Health Foundation’s Behavioural Insights Research Programme (grant no 7601). The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Trial sponsor: Heart of England NHS Foundation Trust.

    • Competing interests None declared.

    • Ethics approval The South Central—Oxford C Research Ethics Committee (16/SC/0554).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement On completion of the study and after publication of the primary manuscript, data requests can be submitted to the lead author (KAS) or chief investigator (IV) of this protocol.