Research for infection protection

Compliance with hand hygiene: knowledge is silver, feeling is golden

“For they don’t do, what they are knowing” – this could be the title of a film on compliance in hand hygiene. And it would not be a comedy, but rather a tragedy.

Hand disinfection is considered the most important measure to prevent hospital-acquired infections. 86 per cent of the staff working in health care are convinced that correct hand hygiene prevents infections. 75 per cent even believe that good and consistent hand hygiene measures may prevent at least half of all nosocomial infections. However, in daily routine, these beliefs are of little help: on average, not even half of all hand disinfection procedures actually necessary for patient protection are carried out.

Researchers at the University of Ulm have looked into this phenomenon from a sociopsychological point of view and discovered: hand hygiene behaviour is very much determined by the implicit attitude towards hand hygiene. In situations, in which people do not have time for cognitive evaluations, these unconscious beliefs help us remain capable of acting, e.g. in stress situations or under time pressure – circumstances typical for patient care.
The actual action or non-action is then carried out impulsively based on automatically activated favourable or unfavourable brain connections. The study demonstrated: the more favourable the implicit attitude of nursing staff and physicians towards hand disinfection, the more frequent they disinfected their hands. The conscious explicit attitudes, however, had no influence on the compliance.

Promoting unconscious positive attitudes in a targeted manner

The promotion of favourable implicit attitudes towards hand disinfection is capable of considerably increasing compliance and with it patient protection. It aims, in particular, to link hand disinfection to pleasant connotations and memorise it as something positive.

The feel on the hand during hand disinfection plays a key role here. The experience is negative when the alcohol of an actually well-tolerated hand disinfection is applied to pre-damaged skin and causes a burning sensation. And the probability that this happens is quite high: 20 to 30 per cent of healthcare workers suffer from skin irritations, often due to too frequent handwashing.

Behavioural changes can break this vicious cycle of experiencing burning sensations during hand disinfection, more frequent handwashing and even stronger burning sensations on a skin that is stressed even more. Also skin-friendly hand disinfectants are an important precondition for the skin’s health.

However, one step further beyond skin tolerability and even more significant for the favourable implicit attitude would be to achieve that users perceive that hand disinfection has a good care effect.

A recent prospective study conducted by the BODE SCIENCE CENTER opens up new perspectives here. The study was to investigate the skincare effect of Sterillium classic pure, the most commonly used hand disinfectant in German clinics and simulated the intensive use of hand disinfectants in clinical routine. Evaluation was done based on measuring data, for example on skin hydration, skin elasticity and transepidermal water loss (TEWL). In addition, in a survey, the participants reported on their subjective perception of hand disinfection.