title: "Priming" hand hygiene compliance in clinical environments.
abstract: BACKGROUND
  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. This study set out to investigate whether priming via olfactory and visual cues influences hand hygiene compliance.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Health Policy, Imperial College London.
authors.forename: Dominic
authors.initials: D
authors.lastname: King
authors.affiliation: Warwick Business School, University of Warwick.
authors.forename: Ivo
authors.initials: I
authors.lastname: Vlaev
authors.affiliation: Center for Patient Safety, University of Miami Miller School of Medicine.
authors.forename: Ruth
authors.initials: R
authors.lastname: Everett-Thomas
authors.affiliation: Center for Patient Safety, University of Miami Miller School of Medicine.
authors.forename: Maureen
authors.initials: M
authors.lastname: Fitzpatrick
authors.affiliation: Centre for Health Policy, Imperial College London.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Center for Patient Safety, University of Miami Miller School of Medicine.
authors.forename: David J
authors.initials: DJ
authors.lastname: Birnbach
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D005431:Florida; D063373:Hand Hygiene / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D013503:Surgery Department, Hospital; D014789:Visitors to Patients / Q000523:psychology* / Q000706:statistics & numerical data