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


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.


Hand 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.

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.


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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

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