Eyes and a citrus smell
could help cut hospital infections
A picture of a man's intense
staring eyes and a clean citrusy smell have been found to substantially
improve hand washing and so cut the risk of hospital infections, according
to a new study.
According to the latest research effective
hand hygiene is the single most important procedure in preventing hospital
acquired infections, which can lead to disease and even death for vulnerable
patients and increase costs for the healthcare system. Yet the number of
staff washing hands is often startlingly low in clinical environments.
Ivo Vlaev, of Warwick Business School, Dominic King and Ara Darzi, of
Imperial College London, and Maureen Fitzpatrick, Ruth Everett Thomas and
David Birnbach, of the University of Miami, used insights from behavioural
science; often called nudges; to improve rates of handwashing in a study at
1 Hospital. They found a picture of a man's eyes saw a ⅓
more people wash their hands, while a citrus smell boosted hand washing by
almost 50%. Professor Vlaev said:- "Appropriate hand hygiene is
considered to be essential practice in clinical environments to prevent
healthcare associated infections. Yet low rates of hand washing are widely
reported and this was reconfirmed in this study, where only 15% of staff and
visitors to an intensive care unit were observed to use the hand washing
In the paper 'Priming' Hand Hygiene Compliance in Clinical
Environments, published in Health Psychology, the researchers experimented
with psychological priming, which is the process where exposure to certain
cues; for example words, smells, or images; alters behaviour without the
person being aware of the impact of the cue on their behaviour.
A trial was set up in a surgical intensive care unit at a teaching hospital
in Miami, Florida. A total of 404 healthcare workers and visitors were
observed to see if they washed their hands by using the hand sanitizer next
to the door before entering a patient's room. In the control group, of 120
visitors just 18 washed their hands (15%). Men on the whole seemed far
sloppier with only 5 out of 54 (9.26%) washing their hands, compared to 13
out of 66 women who washed their hands (19.70%).
A total of 124 visitors were exposed to a
visual cue of a pair of eyes positioned above the alcohol hand gel
dispenser. When exposed to a photograph of male eyes there was a
statistically significant increase in hand washing of 33.3%. However, when
the photograph was of female eyes even less, 10%, washed their hands. Again
males tended to comply with hand hygiene far less than their female
counterparts with 21 women influenced by the male or female eyes and only 5
men, with just 1 man motivated by the female eyes to wash his hands.
Professor Vlaev said:- "This may be because male eyes cue different
feelings, thoughts, or emotions than female eyes. In many previous studies
examining gender differences in exerting social influence more generally,
men have been found to exert more influence than women and this may explain
the differences seen. However, it is important to clarify the male eyes
showed used more facial musculature, often perceived as anger or threat, so
this could have influenced the observed individuals."
There were 160 individuals observed who were exposed to a citrus smell and
they were significantly more likely than the control group to wash their
hands, with 46.9% using the alcohol hand gel dispenser. The citrus
smell seemed to spur more men into action with 35 out of 83 males observed
to wash their hands (42.17%). Females again complied more often, however,
with 40 out 77 (51.95%) complying.
"Based on these preliminary
findings, we believe that further research in this area should be performed
in order to better determine whether priming interventions could be a
powerful tool in encouraging hand washing to improve infection rates.
Further work could look more fully at gender differences in response to
priming based interventions; whether healthcare workers are affected
differently than visitors, and whether the impact is strengthened or diluted
through repeated exposure." said Professor Vlaev.
For a copy of 'Priming' Hand Hygiene Compliance in Clinical
Environments of email:-