Utilizing Group-Based Contingencies to Increase Hand Washing in a Large Human Service Setting
Hand washing is the most important preventative measure for the reduction of contagious disease. Although hand washing is easy to perform, non-adherence is a ubiquitous problem. Several studies have demonstrated the effectiveness of multi-component intervention packages to improve hand washing among employees; however, interventions are limited to acute settings, are often implemented for a short period of time, and rarely, if ever, include information on long-term effectiveness. The purpose of the current study was to utilize a behavior analytic approach to determine the stimulus conditions under which hand washing should occur, and to assess and then implement a long-term monitoring system among direct care workers in a large, non-acute inpatient unit. A single-case repeated measures reversal design was used to evaluate the effectiveness of two interventions aimed at improving hand washing adherence. A lottery was found to be effective in increasing hand hygiene for 2-years with 170 staff.
KeywordsHand washing OBM Lottery Standard precautions Stimulus control
Special thanks to the many data collectors over the years:
Alex Arevalo, Anna Armstrong, Thomas Banz, Mariana Castillo, Monica Lugo, Shari Pincus, Rebecca Stern, Monica Urich
Compliance with Ethical Standards
Conflict of Interest
All authors declare that he/she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was not necessary as the project served as a quality improvement project for staff employed in the hospital.
- Carr, J., Wilder, D., Majdalany, L., Mathisen, D., & Strain, L. (2013). An assessment-based solution to a human-service employee performance problem: An initial evaluation of the Performance Diagnostic Checklist-Human Services. Behavior Analysis in Practice, 6, 16–32. https://doi.org/10.1007/BF03391789.
- Centers for Disease Control and Prevention (2016). Hand hygiene in healthcare settings.Google Scholar
- Conly, J., Hill, S., Ross, J., Lertzman, J., & Louie, T. (1989). Handwashing practices in an intensive care unit: The effects of an educational program and its relationship to infection rates. American Journal of Infection Control, 17, 330–339. https://doi.org/10.1016/0196-6553(89)90002-3.CrossRefGoogle Scholar
- Iwata, B. A., Bailey, J. S., Brown, K. M., Foshee, T. J., & Alpern, M. (1976). A performance-based lottery to improve residential care and training by institutional staff. Journal of Applied Behavior Analysis, 9, 417–431. https://doi.org/10.1901/jaba.1976.9-417.
- Larson, E., McGreer, A., Quraishi, Z., Krenzischek, D., Parsons, B., Holdford, J., & Hierholzer, W. (1991). Effect of an automated sink on hand washing practices and attitudes in high risk units. Infection Control and Hospital Epidemiology, 12, 422–428. https://doi.org/10.2307/30148304
- Luiselli, J., Reed, F., Christian, W., Markowski, W., Rue, H., St. Amand, C., & Ryan, C. (2009). Effects of an informational brochure, lottery-based financial incentive, and public posting on absenteeism of direct-care human service employees. Behavior Modification, 33, 175–181. https://doi.org/10.1177/0145445508320624.CrossRefGoogle Scholar
- Mayer, J. A., Dubbert, P. M., Miller, M., Burkett, P. A., & Chapman, S. W. (1986). Increasing handwashing in an intensive care unit. Infection Control, 7, 259–262. https://doi.org/10.1017/S0195941700064171.
- Mayer, J. A., Mooney, B., Gundlapalli, A., Harbarth, S., Stoddard, G., Rubin, M., Eutropius, L., Brinton, B., & Samore, M. (2011). Dissemination and sustainability of a hospital-wide hand hygiene program emphasizing positive reinforcement. Infection Control and Hospital Epidemiology, 32, 59–66. https://doi.org/10.1086/657666.CrossRefGoogle Scholar
- Occupational Safety and Health Administration (1999). Occupational exposure to bloodborne pathogens. (Publication No. 29, Code of Federal Regulations Part 1910). Washington: Office of the Federal Register, National Archives and Records Administration.Google Scholar
- Raboud, J., Saskin, R., Wong, K., Moore, C., Parucha, G., Bennet, J., Green, K., Low, D., Loeb, M., Simor, A., & McGeer, A. (2004). Patterns of handwashing behavior and visits to patients on a general medical ward of healthcare workers. Infection Control and Hospital Epidemiology, 25, 198–202. https://doi.org/10.1086/502377.CrossRefGoogle Scholar
- The Joint Commission (TJC, 2009). Measuring hand hygiene adherence: Overcoming the challenges. Monograph produced as part of consensus Management in Hand Hygiene (CMHH) project. Printed in USA.Google Scholar
- World Health Organization. (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge: Clean care is safer care. Geneva: World Health Organization, Patient Safety.Google Scholar