Assessing Hand Sanitizer Usage in Japanese Elderly Day Care Centers: An Observational and Interventional Study

Purpose Hand hygiene is a vital preventive measure against the novel coronavirus disease 2019 (COVID-19) infection. Though older people are at high risk of infection of COVID-19, there is still a lack of verification of hand sanitization and effective interventions to promote its implementation for older people. This study aimed to validate what kind of intervention can effectively promote hand hygiene among elderly individuals in Japanese day care centers, based on the hypothesis that a particular nudge will significantly promote hand hygiene. Methods We designed two types of interventions that have aspects of the nudge concept based on WHO Guidelines on Hand Hygiene in Health Care. The study was conducted with one-week observation and intervention periods excluding weekends, starting on February 11, 2023. Three groups were defined as follows: control (installation of hand sanitizer dispenser with a basic sign), reminder (additional visual cues using yellow curing tape), and institutional safety (sign appealing to protecting institutional safety by using hand sanitizer). Daily hand sanitizer usage was measured, and statistical analysis was performed using a one-way ANOVA for the number of uses before and after intervention. Results During the observation period, the average number of hand sanitizer pushes per person remained at 0.39 across all facilities. During the intervention period, control, reminder, and institutional safety groups showed increases of 1.13-fold, 1.31-fold, and 1.16-fold, respectively, revealing no significant difference. Conclusions Though these nudges were implemented according to WHO guidelines and the previous study, the older users of day care centers seemed not to react to these nudges significantly. The results underscore the need for tailored interventions to improve hand hygiene among the elderly in day care settings, contributing to the overall goal of preventing infectious diseases.