Bugs remain a persistent problem in hospitals, and as such there have been numerous attempts to improve hygiene and stop the spread of infections.  A recent study from the University of Warwick suggests a couple of simple nudges that are remarkably effective at changing our behaviours.

The study found that an image of eyes staring at the patient coupled with a citrus like smell worked wonders in encouraging greater hand hygiene.

“Appropriate hand hygiene is considered to be essential practice in clinical environments to prevent healthcare-associated infections,” says Ivo Vlaev of Warwick Business School. “Yet low rates of hand-washing are widely reported and this was reconfirmed in this study, where only 15 percent of staff and visitors to an intensive care unit were observed to use the hand-washing station.”

Nudging better hand hygiene

The study found that using the picture of a man’s eyes saw around 1/3 more people choose to wash their hands than in a control scenario.  Amazingly, the smell of citrus boosted hand washing by a whopping 50%.  The experiment, which took place in an intensive care unit in Florida saw several hundred staff and visitors monitored to track their hand hygiene routines prior to entering a patient’s room.

Of those in the control group, a paltry 15% washed their hands, with men typically worse at this than women.  When people had the male eyes watching what they did however, good behaviour jumped significantly, with 33.3% of people subsequently washing their hands.  Interestingly however, the same was not the case when the eyes in question were female ones.  In this scenario, it actually resulted in a fall in good hand hygiene, with just 10% observing good practice.

“In many previous studies examining gender differences in exerting social influence more generally, men have been found to exert more influence than women and this may explain the differences seen. However, it is important to clarify the male eyes showed used more facial musculature, often perceived as anger or threat, so this could have influenced the observed individuals,” the authors say.

The power of lemon

Interestingly, this improvement was even more pronounced when people were exposed to a citrus smell.  This resulted in nearly half of the participants washing their hands, with a particularly large boost to the male participants.

“Further work could look more fully at gender differences in response to priming-based interventions; whether healthcare workers are affected differently than visitors; and whether the impact is strengthened or diluted through repeated exposure,” the researchers conclude.

Contact Professor Vlaev if you would like to try this out in your own hospital.