Effective ways to improve hand hygiene compliance

Effective hand hygiene is the single most important procedure in preventing hospital-acquired infections. Traditional information/education-based interventions have shown only modest benefits on compliance.

Some traditional methods shown to help encourage compliance with infection prevention measures among staff include motivational programs, administrative measures and training initiatives. For a motivational measure, presenting staff with real-life, personal stories regarding the human cost of HAIs can make an emotional appeal to providers to improve compliance. Administrators can also play a key role in improving compliance by being vocal advocates themselves. If employees understand directives are coming from the top down, they may feel more compelled to comply with them. Consistently retraining employees regarding hygiene best practices and system-wide benefits of compliance helps maintain and improve compliance levels among staff, as well.

Currently, an increasing body of evidence points to behavior modification techniques, like posting signage designed to address health beliefs in strategic locations throughout the hospital, as an underutilized and viable method of boosting infection prevention adherence.

Here’s the study details from Pubmed, the purpose is to investigate whether priming via olfactory & visual affect hand hygiene compliance.


Randomized controlled trial set in a surgical intensive care unit (SICU) at a teaching hospital in Miami, Florida. The primary outcome data involved observations-a mix of health professionals and service users were observed entering the SICU by 2 trained observers and their hand hygiene compliance was independently verified. Interventions included either an olfactory prime (clean, citrus smell) or visual prime (male or female eyes). The primary outcome measure was hand hygiene compliance (HHC) measured by the visitor using the hand gel dispenser.


At a 5% level there was significant evidence that a clean, citrus smell significantly improves HHC (46.9% vs. 15.0%, p = .0001). Compared to the control group, a significant improvement in HHC was seen when a picture of “male eyes” was placed over the hand gel dispenser (33.3% vs. 15.0%, p < .038). No significant improvement in HHC was seen when a picture of female eyes was placed over the same hand gel dispenser (10.0% vs. 15.0%, p = .626).


This is one of the first studies to demonstrate that priming can influence HHC in a clinical setting. The findings suggest that priming interventions could be used to change other behaviors relevant to public health.