| Description |
Hand hygiene frequency in hospitals is unacceptably low. To date, this problem has been approached from a technical standpoint, with intervention designs that lack a theoretical foundation in human behavior. Almost all interventions have failed to significantly increase hand hygiene frequency. The hypothesis of this work is that identifying hand hygiene interventions guided by psychological theory and principles will lead to more effective interventions. The goal of this study was to develop a lab-based paradigm to explore how principles of adherence engineering, specifically the minimization of cognitive and physical effort, affect the frequency of performing hand hygiene. The paradigm was used to explore the principles of physical and cognitive effort. Participants were asked to paint a series of circles in different colors, but were only given a single paint brush. After painting each circle they could choose if they wanted to wash the brush. In the first experiment, participants painted at varying distances from the washing station to explore the impact of physical effort on washing frequency. In the second experiment, participants were asked to memorize a varying number of digits while painting each circle to explore the impact of cognitive effort on washing frequency. Performance and observational data were collected. Physical distance from the washing station had a significant impact on brush washing frequency. When no cognitive load was present, the perception of risk of contamination accounted for the largest proportion of variation in brush washing frequency. The presence of a cognitive load was associated with an increase in washing frequency, with contamination risk having little effect on washing behavior. Physical distance to a hand washing station will have an effect on hand washing behavior. When the cognitive load of health care workers is increased, it is possible that they will revert to a default behavior because they do not have the mental resources necessary to develop a situation-specific washing strategy. In current hospital environments, the default behavior seems to be omitting hand hygiene. Future interventions should aim at reversing this default behavior in order to improve hand hygiene. |
