Advertisement

Utilizing Group-Based Contingencies to Increase Hand Washing in a Large Human Service Setting

  • Lynn G. BowmanEmail author
  • Samantha L. Hardesty
  • Sigurdur O. Sigurdsson
  • Melissa McIvor
  • Phillip M. Orchowitz
  • Leaora L. Wagner
  • Louis P. Hagopian
Research Article

Abstract

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.

Keywords

Hand washing OBM Lottery Standard precautions Stimulus control 

Notes

Acknowledgments

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.

Ethical Approval

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

Informed consent was not necessary as the project served as a quality improvement project for staff employed in the hospital.

References

  1. Aiello, A., Coulbourn, R., Perez, V., & Larson, E. (2008). Effect of hand hygiene on infectious disease risk in the community setting: A meta-analysis. American Journal of Public Health, 98, 1372–1381.CrossRefGoogle Scholar
  2. Babcock, R. A., Sulzer-Azaroff, B., & Sanderson, M. (1992). Increasing nurses’ use of feedback to promote infection-control practices in a head-injury treatment center. Journal of Applied Behavior Analysis, 25, 621–627.  https://doi.org/10.1901/jaba.1992.25-621.CrossRefGoogle Scholar
  3. 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.
  4. Centers for Disease Control and Prevention (2016). Hand hygiene in healthcare settings.Google Scholar
  5. 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
  6. Creedon, S. (2005). Healthcare workers’ hand decontamination practices: Compliance with recommended guidelines. Issues and Innovations in Nursing Practice, 51, 208–216.  https://doi.org/10.1111/j.1365-2648.2005.03490.x.Google Scholar
  7. DeVries, J., Burnette, M., & Redmon, W. (1991). AIDS prevention: Improving nurses’ compliance with glove wearing through performance feedback. Journal of Applied Behavior Analysis, 24, 705–711.  https://doi.org/10.1901/jaba.1991.24-705.CrossRefGoogle Scholar
  8. Dubbert, P., Dolce, J., Richter, W., Miller, M., & Chapman, S. (1990). Increasing ICU staff hand washing: Effects of education and group feedback. Infection Control and Hospital Epidemiology, 11, 191–193.  https://doi.org/10.1177/1054773805282445.CrossRefGoogle Scholar
  9. Erasmus, V., Daha, T., Brug, H., Richardus, J., Behrendt, M., Vos, M., & Beeck, E. (2010). Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control and Hospital Epidemiology, 31, 283–294.  https://doi.org/10.1086/650451.CrossRefGoogle Scholar
  10. Gould, D., Drey, N., Moralejo, D., Grimshaw, J., & Chudleigh, J. (2008). Interventions to improve hand hygiene compliance in patient care. Journal of Hospital Infection, 68, 193–202.  https://doi.org/10.1016/j.jhin.2007.11.013.CrossRefGoogle Scholar
  11. 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.
  12. Khatib, M., Ghassan, J., Abdallah, A., & Ibrahim, Y. (1999). Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest, 116, 172–175.  https://doi.org/10.1378/chest.116.1.172.CrossRefGoogle Scholar
  13. 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
  14. 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
  15. Luke, M., & Alvosius, M. (2011). Adherence with universal precautions after immediate personalized performance feedback. Journal of Applied Behavior Analysis, 44, 967–971.CrossRefGoogle Scholar
  16. 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.
  17. 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
  18. Miller, M., Carlson, J., & Sigurdsson, S. (2014). Improving treatment integrity in a human service setting using lottery-based incentives. Journal of Organizational Behavior Management, 34, 29–38.CrossRefGoogle Scholar
  19. Naikoba, S., & Hayward, A. (2001). The effectiveness of interventions aimed at increasing hand washing in healthcare workers: A systematic review. Journal of Hospital Infection, 47, 173–180.  https://doi.org/10.1056/jhin.2000.0882.CrossRefGoogle Scholar
  20. 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
  21. 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
  22. Stephens, S., & Ludwig, T. (2005). Improving anesthesia nurse compliance with universal precautions using group goals and public feedback. Journal of Organizational Behavior Management, 25, 37–71.  https://doi.org/10.1300/J075v2502-02.CrossRefGoogle Scholar
  23. 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
  24. VanStelle, S., Vicars, S., Harr, V., Miguel, C., Koerber, J., Kazbour, R., & Austin, J. (2012). The publication history of. Journal of Organizational Behavior Management, 32, 93–123.  https://doi.org/10.1080/01608061.2012.675864.CrossRefGoogle Scholar
  25. 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

Copyright information

© Association for Behavior Analysis International 2019

Authors and Affiliations

  • Lynn G. Bowman
    • 1
    • 2
    Email author
  • Samantha L. Hardesty
    • 1
    • 3
  • Sigurdur O. Sigurdsson
    • 3
  • Melissa McIvor
    • 1
  • Phillip M. Orchowitz
    • 1
  • Leaora L. Wagner
    • 1
  • Louis P. Hagopian
    • 1
    • 2
  1. 1.Neurobehavioral UnitKennedy Krieger InstituteBaltimoreUSA
  2. 2.Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.University of Maryland, Baltimore CountyBaltimoreUSA

Personalised recommendations