Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T07:03:25.417Z Has data issue: false hasContentIssue false

Social Marketing Analysis of 2 Years of Hand Hygiene Promotion

Published online by Cambridge University Press:  02 January 2015

Manuel W. Mah*
Affiliation:
Faculty of Medicine, University of Calgary, Calgary
Yat Cho Tam
Affiliation:
O'Brien Centre for the Bachelor of Health Sciences Program, University of Calgary, Calgary
Sameer Deshpande
Affiliation:
Faculty of Management, University of Lethbridge, Lethbridge, Alberta, Canada
*
Infection Prevention and Control, Rockyview General Hospital, 7007 14th Street SW, Calgary, AB T2V 1P9, Canada (manuel.mah@calgaryhealthregion.ca)

Abstract

Objective.

To assess published hand hygiene behavioral interventions that employed a social marketing framework and to recommend improvements to future interventions.

Methods.

We performed a systematic literature review by searching the PubMed database and the Cumulative Index to Nursing and Allied Health Literature for published articles about hand hygiene behavioral interventions in healthcare facilities, schools, and community settings. Our analysis included articles that describe multifaceted interventions and evaluated them with predefined social marketing benchmark criteria.

Results.

Of 53 interventions analyzed in this review, 16 (30.2%) employed primary formative audience research, 5 (9.4%) incorporated social or behavioral theories, 27 (50.9%) employed segmentation and targeting of the audience, 44 (83.0%) used components of the “marketing mix,” 3 (5.7%) considered the influence of competing behaviors, 7 (13.2%) cultivated relationships with the target audience, and 15 (28.3%) provided simple behavioral messages. Thirty-five (66.0%) of the interventions demonstrated a significant improvement in performance, but only 21 (39.6%) were considered to have a strong evaluative design. The median duration of the interventions was 8.0 months.

Conclusions.

From a social marketing perspective, the promotion of hand hygiene could be improved in several ways. The effectiveness of social marketing in hand hygiene promotion should be tested in future interventions.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.World Health Organization (WHO). WHO guidelines on hand hygiene in health care in health care (advance draft), version: April 2006. Available at: http://www.who.int/patientsafety/information_centre/ghhad_download/en/index.html. Accessed June 2, 2006.Google Scholar
2.Naikoba, S, Hayward, A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers—a systematic review. J Hosp Infect 2001;47:173180.CrossRefGoogle ScholarPubMed
3.Larson, E. State-of-the-science—2004: time for a “no excuses/no tolerance” (NET) strategy. Am J Infect Control 2005;33:548557.CrossRefGoogle ScholarPubMed
4.Whitby, M, Pessoa-Silva, CL, McLaws, ML, et al.Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2007;65:18.CrossRefGoogle ScholarPubMed
5.Andreasen, AR. Marketing social marketing in the social change marketplace. J Public Policy Marketing 2002;21:313.CrossRefGoogle Scholar
6. National Social Marketing Centre, United Kingdom. Social marketing benchmark criteria tool. Available at: http://www.nsms.org.uk/public/default.aspx?PageID=20. Accessed October 7, 2007.Google Scholar
7.Kotler, P, Roberto, N, Lee, N. Social Marketing: Improving the Quality of Life. 2nd ed. Thousand Oaks, CA: Sage Publications; 2002.Google Scholar
8.Wenzel, RP, Pfaller, MA. Handwashing: efficacy versus acceptance. A brief essay. J Hosp Infect 1991;18(suppl B):6568.CrossRefGoogle ScholarPubMed
9.Mah, MW, Deshpande, S, Rothschild, ML. Social marketing: a behavior change technology for infection control. Am J Infect Control 2006;34:452457.CrossRefGoogle ScholarPubMed
10.Curtis, VA, Garbrah-Aidoo, N, Scott, B. Masters of marketing: bringing private sector skills to public health partnerships. Am J Pub Health 2007;97:634641.CrossRefGoogle ScholarPubMed
11.Gordon, R, McDermott, L, Stead, M, Angus, K. The effectiveness of social marketing interventions for health improvement: what's the evidence? Public Health 2006;120:11331139.CrossRefGoogle ScholarPubMed
12.Rothschild, ML. Carrots, sticks, and promises: a conceptual framework for the management of public health and social issue behaviors. J Marketing 1999;63:2437.CrossRefGoogle Scholar
13.Lefebvre, RC. Theories and models in social marketing. In: Bloom, PN, Gundlach, GT, eds. Handbook of Marketing and Society. Thousand Oaks, CA: Sage Publications, 2000:506518.Google Scholar
14.Vargo, SL, Lusch, RF. Evolving to a new dominant logic for marketing. J Mark 2004;68:117.CrossRefGoogle Scholar
15.Hastings, G. Relational paradigms in social marketing. J Macromark 2003;23:615.CrossRefGoogle Scholar
16.Grimshaw, J, Campbell, M, Eccles, M, Steen, N. Experimental and quasi-experimental designs for evaluating guideline implementation strategies. Family Practice 2000;17:S11S18.CrossRefGoogle ScholarPubMed
17.Antoniak, J. Handwashing compliance. Can Nurse 2004;100:2125.Google ScholarPubMed
18.Aragon, D, Sole, ML, Brown, S. Outcomes of an infection prevention project focusing on hand hygiene and isolation practices. AACN Clin Issues 2005;16:121132.CrossRefGoogle ScholarPubMed
19.Bartel, J. Resistant organisms necessitate total compliance. Nurs Manage 2005;36:5254.CrossRefGoogle ScholarPubMed
20.Bischoff, WE, Reynolds, TM, Sessler, CN, Edmond, MB, Wenzel, RP. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160:10171021.CrossRefGoogle ScholarPubMed
21.Brown, SM, Lubimova, AV, Khrustalyeva, NM, et al.Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:172179CrossRefGoogle Scholar
22.Camins, BC, Fraser, VJ. Reducing the risk of health care-associated infections by complying with CDC hand hygiene guidelines. Jt Comm J Qual Patient Saf 2005;31:173179.Google ScholarPubMed
23.Colombo, C, Giger, H, Grote, J, et al.Impact of teaching interventions on nurse compliance with hand disinfection. J Hosp Infect 2002;51:6972.CrossRefGoogle ScholarPubMed
24.Creedon, SA. Healthcare workers' hand decontamination practices: compliance with recommended guidelines. J Adv Nurs 2005;51:208216.CrossRefGoogle ScholarPubMed
25.Dorsey, ST, Cydulka, RK, Emerman, CL. Is handwashing teachable? Failure to improve handwashing behavior in an urban emergency department. Acad Emerg Med 1996;3:360365.CrossRefGoogle Scholar
26.Earl, ML, Jackson, M, Rickman, LS. Improved rates of compliance with hand antisepsis guidelines: a three-phase observational study. Am J Nurs 2001;101:2633.CrossRefGoogle ScholarPubMed
27.Girard, R, Amazian, K, Fabry, J. Better compliance and better tolerance in relation to a well-conducted introduction to rub-in hand disinfection. J Hosp Infect 2001;47:131137.CrossRefGoogle ScholarPubMed
28.Girou, E, Oppein, F. Handwashing compliance in a French university hospital: new perspective with the introduction of hand-rubbing with a waterless alcohol-based solution. J Hosp Infect 2001;48:S55S57.CrossRefGoogle Scholar
29.Gopal Rao, G, Jeanes, A, Osman, M, Aylott, C, Green, J. Marketing hand hygiene in hospitals—a case study. J Hosp Infect 2002;50:4247.CrossRefGoogle ScholarPubMed
30.Graham, M. Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:7781.CrossRefGoogle Scholar
31.Harbarth, S, Pittet, D, Grady, L, et al.Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J 2002;21:489495.CrossRefGoogle ScholarPubMed
32.Hilburn, J, Hammond, BS, Fendler, EJ, Groziak, PA. Use of alcohol hand sanitizer as an infection control strategy in an acute care facility. Am J Infect Control 2003;31:109116.CrossRefGoogle Scholar
33.Johnson, PD, Martin, R, Burrell, LJ, et al.Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005;183:509514.CrossRefGoogle Scholar
34.Lam, BC, Lee, J, Lau, YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics 2004;114:e565e571.CrossRefGoogle Scholar
35.Larson, EL, Bryan, JL, Adler, LM, Blane, C. A multifaceted approach to changing handwashing behavior. Am J Infect Control 1997;25:310.CrossRefGoogle ScholarPubMed
36.Larson, EL, Early, E, Cloonan, P, Sugrue, S, Parides, M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 2000;26:1422.CrossRefGoogle ScholarPubMed
37.Lohr, JA, Ingram, DL, Dudley, SM, Lawton, EL, Donowitz, LG. Hand washing in pediatric ambulatory settings: an inconsistent practice. Am J Dis Child 1991;145:11981199.CrossRefGoogle ScholarPubMed
38.MacDonald, A, Dinah, F, MacKenzie, D, Wilson, A. Performance feedback of hand hygiene, using alcohol gel as the skin decontaminant, reduces the number of inpatients newly affected by MRSA and antibiotic costs. J Hosp Infect 2004;56:5663.CrossRefGoogle ScholarPubMed
39.Marena, C, Lodola, L, Zecca, M, et al.Assessment of handwashing practices with chemical and microbiologic methods: preliminary results from a prospective crossover study. Am J Infect Control 2002;30:334340.CrossRefGoogle ScholarPubMed
40.Maury, E, Alzieu, M, Baudel, JL, et al.Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am J Respir Crit Care Med 2000;162:324327.CrossRefGoogle Scholar
41.Mayer, JA, Dubbert, PM, Miller, M, Burkett, PA, Chapman, SW. Increasing handwashing in an intensive care unit. Infect Control 1986;7:259262.CrossRefGoogle Scholar
42.Mody, L, McNeil, SA, Sun, R, Bradley, SE, Kauffman, CA. Introduction of a waterless alcohol-based hand rub in a long-term care facility. Infect Control Hosp Epidemiol 2003;24:165171.CrossRefGoogle ScholarPubMed
43.Muto, CA, Sistrom, MG, Farr, BM. Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control 2000;28:273276.CrossRefGoogle ScholarPubMed
44.Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000;356:13071312.CrossRefGoogle ScholarPubMed
45.Salemi, C, Canola, MT, Eck, EK. Hand washing and physicians: how to get them together. Infect Control Hosp Epidemiol 2002;23:3235.CrossRefGoogle ScholarPubMed
46.Samuel, R, Almedom, AM, Hagos, G, Albin, S, Mutungi, A. Promotion of handwashing as a measure of quality of care and prevention of hospital-acquired infections in Eritrea: the Keren study. Afr Health Sci 2005;5:413.Google ScholarPubMed
47.Sharek, PJ, Benitz, WE, Abel, NJ, Freeburn, MJ, Mayer, ML, Bergman, DA. Effect of an evidence-based hand washing policy on hand washing rates and false-positive coagulase negative staphylococcus blood and cerebro-spinal fluid culture rates in a level III NICU. J Perinatol 2002;22:137143.CrossRefGoogle Scholar
48.Storr, J. The effectiveness of the national Clean Your Hands Campaign. Nurs Times 2005;101:5051.Google Scholar
49.Thomas, M, Gillespie, W, Krauss, J, et al.Focus group data as a tool in assessing effectiveness of a hand hygiene campaign. Am J Infect Control 2005;33:368373.CrossRefGoogle ScholarPubMed
50.Tibballs, J. Teaching hospital medical staff to handwash. Med J Aust 1996;164:395398.CrossRefGoogle ScholarPubMed
51.Zerr, DM, Allpress, AL, Heath, J, Bornemann, R, Bennett, E. Decreasing hospital-associated rotavirus infection: a multidisciplinary hand hygiene campaign in a children's hospital. Pediatr Infect Dis J 2005;24:397403.CrossRefGoogle ScholarPubMed
52.Dyer, DL, Shinder, A, Shinder, F. Alcohol-free instant hand sanitizer reduces elementary school illness absenteeism. Earn Med 2000;32:633638.Google ScholarPubMed
53.Early, E, Battle, K, Cantwell, E, English, J, Lavin, JE, Larson, E. Effect of several interventions on the frequency of handwashing among elementary public school children. Am J Infect Control 1998;26:263269.CrossRefGoogle ScholarPubMed
54.Guinan, M, McGuckin, M, Ali, Y. The effect of a comprehensive handwashing program on absenteeism in elementary schools. Am J Infect Control 2002;30:217220.CrossRefGoogle ScholarPubMed
55.Hammond, B, Ali, Y, Fendler, E, Dolan, M, Donovan, S. Effect of hand sanitizer use on elementary school absenteeism. Am J Infect Control 2000;28:340346.CrossRefGoogle ScholarPubMed
56.Kimel, LS. Handwashing education can decrease illness absenteeism. J Sch Nurs 1996;12:14-16, 18.CrossRefGoogle ScholarPubMed
57.Morton, JL, Schultz, AA. Healthy hands: use of alcohol gel as an adjunct to handwashing in elementary school children. J Sch Nurs 2004;20:161167.CrossRefGoogle ScholarPubMed
58.Rosen, L, Manor, O, Engelhard, D, et al.Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools. Prev Med 2006;42:2732.CrossRefGoogle ScholarPubMed
59.Alam, N, Wojtyniak, B, Henry, FJ, Rahaman, MM. Mothers' personal and domestic hygiene and diarrhoea incidence in young children in rural Bangladesh. Int J Epidemiol 1989;18:242247.CrossRefGoogle ScholarPubMed
60.Curtis, V, Kanki, B, Cousens, S, et al.Evidence of behaviour change following a hygiene promotion programme in Burkina Faso. Bull World Health Organ 2001;79:518527.Google ScholarPubMed
61.Luby, SP, Agboatwalla, M, Feikin, DR, et al.Effect of handwashing on child health: a randomised controlled trial. Lancet 2005;366:225233.CrossRefGoogle ScholarPubMed
62.Pinfold, JV. Analysis of different communication channels for promoting hygiene behaviour. Health Educ Res 1999;14:629639.CrossRefGoogle ScholarPubMed
63.Pinfold, JV. Faecal contamination of water and fingertip-rinses as a method for evaluating the effect of low-cost water supply and sanitation activities on faeco-oral disease transmission. II. A hygiene intervention study in rural north-east Thailand. Epidemiol Infect 1990;105:377389.CrossRefGoogle Scholar
64.Shahid, NS, Greenough, WB 3rdSamadi, AR, Huq, MI, Rahman, N. Hand washing with soap reduces diarrhoea and spread of bacterial pathogens in a Bangladesh village. J Diarrhoeal Dis Res 1996;14:8589.Google Scholar
65.Wilson, JM, Chandler, GN. Sustained improvements in hygiene behaviour amongst village women in Lombok, Indonesia. Trans R Soc Trop Med Hyg 1993;87:615616.CrossRefGoogle ScholarPubMed
66.Finney, JW, Miller, KM, Adler, SP. Changing protective and risky behaviors to prevent child-to-parent transmission of cytomegalovirus. J Appl Behav Anal 1993;26:471472.CrossRefGoogle ScholarPubMed
67.Ryan, MA, Christian, RS, Wohlrabe, J. Handwashing and respiratory illness among young adults in military training. Am J Prev Med 2001;21:7983.CrossRefGoogle ScholarPubMed
68.Sandora, TJ, Taveras, EM, Shih, MC, et al.A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home. Pediatrics 2005;116:587594.CrossRefGoogle ScholarPubMed
69.White, C, Kolble, R, Carlson, R, et al.The effect of hand hygiene on illness rate among students in university residence halls. Am J Infect Control 2003;31:364370.CrossRefGoogle ScholarPubMed
70.Smith, B. Notes from the field: avoiding the post campaign blues. Soc Mar Q 2004;10:6063.CrossRefGoogle Scholar
71.Gould, DJ, Hewitt-Taylor, J, Drey, NS, Gammon, J, Chudleigh, J, Weinberg, JR. The Clean Your Hands Campaign: critiquing policy and evidence base. J Hosp Infect 2007;65:95101.CrossRefGoogle Scholar
72.Andreasen, AR. Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment. San Francisco: Jossey-Bass; 1995:107.Google Scholar
73.Stanton, B, Black, R, Engle, P, Pelto, G. Theory-driven behavioral intervention research for the control of diarrheal diseases. Soc Sci Med 1992;35:14051420.CrossRefGoogle ScholarPubMed
74.Lefebvre, RC. The new technology: the consumer as participant rather than target audience. Soc Mark Q 2007;13:3142.CrossRefGoogle Scholar
75.McKenzie-Mohr, D, Smith, W. Fostering Sustainable Behaviour: An Introduction to Community-Based Social Marketing. Gabriola Island, BC: New Society Publishers, 1999:93.Google Scholar
76.Campbell, M, Fitzpatrick, R, Haines, A, et al.Framework for design and evaluation of complex interventions to improve health. BMJ 2000;321:694696.CrossRefGoogle ScholarPubMed
77.Turning Point National Excellence Collaboratives. Social Marketing. Available at: http://www.turningpointprogram.org/Pages/socialmkt.html. Accessed October 7, 2007.Google Scholar
78.National Social Marketing Centre, United Kingdom. Available at: http://www.nsms.org.uk/public/. Accessed October 7, 2007.Google Scholar
79.Sowers, W, French, J, Blair-Stevens, C. Lessons learned from social marketing models in the United Kingdom. Soc Mark Q 2007;13:5862.CrossRefGoogle Scholar