How can we influence healthcare workers to better comply with infection control guidelines/measures. Talk during IFIC, Vienna 18-03-2016

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… at least
I try
¤ 24 hospitals in the NL (ICUs & surgery)
¤ 19% overall compliance
² 3% before
² 22% aGer
¤ No difference between RN en MD
¤ Smaller hospitals beOer than bigger
Vicky Erasmus Inf Control Hosp Epidemiol 2009

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¤ We look, others don’t …
¤ Our surveillance is too good
(no Hawthorne effect) …
¤ No one can do beOer …
¤ Five indicaYons are
(two) too many …
¤ Handhygiene is only one
of the measures …

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Source: Health ProtecYon Scotland, January 2013
They are both (or the car, will be soon) full-of-sh…

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hOp://www.hha.org.au/LatestNaYonalData.aspx
Why don’t they listen to InfecYon Control?
Policing One-track mind
Guidelines
Guidelines
Guidelines
Guidelines
More
guidelines
…
& more
ESBL
CRE
MRSA
MDR-AB
XDR-TB
PRP
MERS-Cov
C.dif
Noro
Flu
Please,
no more!

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5
IC needs to be to-the-point
MRSA
ESBL
C.dif & Co
CRE
…..
HAI - prevenYon
CommunicaYon
¤ Structure & design
¤ Know why
¤ Learning from others
¤ Structure & design
¤ Know why
¤ Learning from others

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¤ IntuiYve
¤ Clear
¤ SeducYve
¤ Force?
¤ Award
Mirror in elevator
² More room
² Change of behavior
¤ Structure & design
¤ Know why
¤ Learning from others
Standard
Hospital
We are a great
hospital
Good doctors,
Caring nurses…
Trust us!
We “care`’ about
the physical and
mental health of
our paYents
We do so by
ensure easy
access, one stop
shop, and a
healing
environment
Which happens to
make us a great
hospital.
Trust us?
Your Hospital
Why
How
What
Computer
Company X
We make great
computers
BeauYful design,
user friendly …
buy one?
Everything we do
We believe in
challenging
the status quo,
we believe in
thinking differently
We do so by
making our
products
beauYful designed,
and user friendly
Which happens to
make great
computers.
Buy one?
Apple
Why
How
What
Others
Disinfect your
hands
Use ABHR
Do it!
We want to
implement
efficient and
effecYve ways to
increase our
paYents safety
We placed ABHR
at the point of
care for your use
High compliance =
paYents safety
You
Simon Sinek’s Golden Cycle

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¤ Never tried it for InfecYon Control
² your “mission statement” could be constructed
like this
² Write it on your walls, screen savers, …
² use when teaching
² use when arguing with those non-compliant
² use in paYent folder
¤ Structure & design
¤ Know why
¤ Learning from others
¤ High-risk industries
² commercial aviaYon
² oil and gas industry
¤ MarkeYng
¤ Behavioral science
¤ Media
Almost Good, MD

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… the pilot will be among the dead
• Education
• System change
• Motivation
You do agree with me that we don’t want
a wide-spread epidemic, don’t you?
first MRSA isolate was recovered within 72 h of ICU admission
first MRSA isolated aGer 72 h of ICU admission
P < 0.01
Pre-SARS Post-SARS
SARS
Clin Infect Dis 2004;39:511-516
PaYent involvement: … they cannot and should not be responsible for their
own safety in an environment over which they have no control
George Annas NEJM 354;19:2063-2066

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• 89% of the photos displaying doctors were
incorrect
• 31% of the photos displaying nurses were
incorrect
• It seems that the stereotype image of a
doctor does not agree with the current hand
hygiene guidelines.
• If we aim for higher compliance rates with IC
measures, we need to change the social image
of HCWs
¤ PresenYng something new and improved does
not automaYcally change bahavior !
¤ ‘The lesson from markeYng is that people are
more willing to change their behaviour when
they feel good, flaOered, challenged powerful,
sexy or proud, than when they are flooded
with facts’ (Hodgkin 1999)
Onya, the Redskins cheerer
(who asked that her last name
be withheld, ciYng team policy),
has her picture on the team's
Web site in her official bikini-
like uniform and also reclining
in an actual bikini. Onya, 27,
who declined to idenYfy the
company she works for, is but
one of several drug
representaEves who have
cheered for the Redskins

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Thus never again
say that the
majority doesn’t
comply with IC
Asch conformity experiments
¤ Does beOer payment leads to more effort
¤ 600 people walking by were asked to help unloading a
sofa from a truck
² Group A: “just asked”
² Group B: “offered 50 cent ahead”
² Willingness to help in group B significantly lower
² Willingness of group B only comparable to group A at $5
¤ Praise >> Money, and we can not afford to pay for
beOer compliance
Heyman J, Ariely D. Psychol Sci 2004;15:787-793
www.sciencexpress.org / 20 November 2008 / Page 1 / 10.1126/science.1161405
§ Orderly alley:
33% liOering
§ GraffiY alley:
§ 69% liOering
¤ when people observe inappropriate behavior, this
weakens their concern for appropriateness
§ Orderly alley
§ No graffiY sign
§ Flyer on handlebar
§ avoid liOering
We need “order” in our hospitals and people showing appropriate behavior !

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¤ An innocent associaYon with
either bad or good things will
influence how people feel
about us or a product
² The good looking models next to
the car
² RaYng of idenYcal car changed with
and without model
² Men didn’t believe that their
judgment was influenced
§ Culture change
(CEO directive and save/open communication)
§ State your motivation (“why”)
§ Better design
§ Patient’s involvement
§ Media support
§ A (supportive) inspectorate