J Hosp Infect. 2013 Nov;85(3):220-5.

Impact of an educational intervention upon the hand hygiene compliance of children.

J. Randlea, J. Metcalfeb, H. Webbc, J.C.A. Luckettd, B. Nerlichc, N. Vaughana, J. Segalb, K.R. Hardied,*

a School of Nursing, Physiotherapy and Midwifery, University of Nottingham, Queen’s Medical Centre, Nottingham, UK

b School of Engineering, University of Nottingham, Nottingham, UK

c School of Sociology and Science Policy, University of Nottingham, University Park, Nottingham, UK

d School of Molecular Medical Sciences, Centre for Biomolecular Sciences, University of Nottingham, University Park, Nottingham, UK

 

ABSTRACT:

Background: Hand hygiene compliance is the single most effective way to reduce healthcare-associated infections. Children are notoriously vulnerable to infection as well as acting as conduits to transmission. Based on these observations, the authors formulated the hypothesis that behavioural change which improved children’s hand hygiene compliance would decrease the spread of infectious diseases.

Aim: To create an educational intervention to induce long-term behavioural change culminating in increased hand hygiene compliance of children, and thus a decrease in the rate of infections.

Methods: Focus groups conducted during interactive teaching sessions identified what children felt would help them to increase their hand hygiene compliance. This informed the design of an educational device that was subsequently trialled to measure its effectiveness in increasing hand hygiene compliance. Initial developmental stages were conducted in two schools in the East Midlands with study participants aged 5e8 years; the device was subsequently used in a healthcare setting to assess deployment flexibility.

Findings: Focus groups indicated that children enjoyed interactive learning, developed knowledge about cross-transmission of infections, and became motivated to encourage others to improve hand hygiene compliance. Microbiological swabbing verified the presence of pathogens on children’s hands and environmental surfaces that could serve as reservoirs of infection, and questionnaires indicated an increase in handwashing following the intervention.

Conclusion: Educational interventions have the potential to increase hand hygiene and reduce the transmission of infections.

 

SUPPLEMENT:

Evidence suggests that hand hygiene is the single most effective preventative measure against the spread of infections, with one third of infections being prevented by improving hand hygiene practices. This may be linked to the detection of faecal matter on the hands of one quarter of the adults tested. Despite this, few strategies aimed at improving effective, sustainable hand hygiene practices in the general public have been attempted. Children in particular are particularly vulnerable to infection and act as vehicles of transmission, and it was hypothesized that an intervention aimed at improving the hand hygiene compliance of children would decrease the spread of infectious diseases and have the potential of creating a lifelong effect.

This study describes the development of an educational intervention that induces long-term behavioural change that incorporates increased hand hygiene compliance in children. Interactive teaching sessions were conducted to identify what the children felt would help increase their hand hygiene compliance (Figure 1). This information was used as the basis of the design of an educational device that was trialled in schools and healthcare settings (Figure 2). The Glo-yo device dispenses a non-toxic cream that children apply to their hands to create invisible surrogate germs. The UV lights incorporated into the Glo-yo are used to illuminate the cream, and the animation delivers images of the six steps to follow for effective hand gygiene to remove germs over the recommended 20 seconds. The UV lights enable the children to check that the surrogate germs are gone after performing these actions. The Glo-yo can be seen in action via links to the BBC news coverage and the University of Nottingham Impact Campaign website.

Linking the act of hand hygiene to the educational message in this way goes beyond the information provided on leaflets/posters to stimulate behavioural change. To confirm this, focus groups indicated that the children aged 5-8 years enjoyed the interactive learning, developed knowledge about cross-transmission of infections and were motivated to encourage others to also improve their hand hygiene.

Ongoing trials are providing further evidence of this positive effect.

Figure-1-froniers-HardieFigure 1. Interactive teaching sessions were conducted to identify what the children felt would help increase their hand hygiene compliance.

 

Figure-2-froniers-HardieFig 2. The Glo-yo devise functionality is shown alongside the positive comments of the children, parents and teachers involved in the design and trial. The UV-lights and how they illuminate hands is indicated, as are the 6 images depicting the steps of hand hygiene that are displayed on the screen as instructions.

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