Developing a design-based concept to improve hand hygiene in the neonatal intensive care unit

Area of Science:

• Healthcare-associated infection prevention
• Behavioral science in healthcare
• Neonatal intensive care unit (NICU) practices

Background:

• Hand hygiene (HH) is paramount for preventing nosocomial infections in the NICU.
• Sustaining adequate HH compliance rates presents a persistent challenge.
• Existing HH guidelines are often unrealistic due to high workload and competing clinical priorities.

Purpose of the Study:

• To develop a design-based concept to facilitate and improve HH behavior in the NICU.
• To address the challenges of compliance with HH guidelines in a high-pressure environment.
• To leverage behavioral change frameworks and nudge theory for enhanced HH practices.

Main Methods:

• Concept development based on a theoretical framework and contextual field studies.
• Identification of causes for poor HH compliance through focus group sessions.
• Iterative testing of low-fidelity prototypes for feasibility, usability, and acceptability.

Main Results:

• The developed concept is "Island-based nursing," dividing patient rooms into "island" and "general" zones.
• HH is indicated upon entering/exiting the island zone and after touching surfaces in the general zone.
• Illuminated demarcation of the island zone acts as a visual nudge to prompt HH.

Conclusions:

• Island-based nursing simplifies and optimizes HH indications.
• The concept offers an innovative, intuitive, and user-friendly approach to HH compliance.
• This strategy enhances HH adherence by making it more practical within demanding clinical workflows.