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. 2012 May 1;21(1):152–164. doi: 10.5210/bsi.v21i0.3979

Effects of Response Cost and Socially-Assisted Interventions on Hand-Hygiene Behavior of University Students

Angela K Fournier 1,✉, Thomas D Berry 2
PMCID: PMC7149071  PMID: 38624290

Abstract

A field study was conducted to examine the effect of interventions to increase hand-hygiene behavior of university students. Student patrons of a university cafeteria were observed during lunch. Across several phases, researchers observed and recorded the number of students (a) entering the restroom to wash hands and (b) using a hand-sanitizer gel. Interventions included an informational poster, hand-sanitizer dispenser, and change agent to increase hand-hygiene behavior. Results showed that the presence of a strategically placed hand-sanitizer dispenser was effective in increasing hand-hygiene behavior from 1.52% to over 60% (average n = 208 students per day). Participants were particularly responsive to the hand-sanitizer dispenser when combined with a change agent. Meanwhile, the tested interventions were ineffective in increasing the number of students entering a restroom to hand wash. The results are discussed regarding response cost and socially-mediated consequences of change agents.

Keyword: hand hygiene, hand-sanitizer gels, hand washing, change agent interventions, social assistance

References

  1. Aiello, A. E., Coulborn, R. M, Perez, V., & Larson, E. L. (2008). Effect of hand hygiene on infectious disease risk in the community setting: A meta-analysis. American Journal of Public Health, 98(8), 1372–1381. doi: 10.2105/AJPH.2007.124610 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Aiello, A. E., Perez, V., Coulborn, R. M, Davis, B. M., Uddin, M., & Monto, A. S. (2012). Facemasks, hand hygiene, and influenza among young adults: A randomized intervention trial. PLOS One, 7(1), e29744. doi: 10.1371/journal.pone.0029744 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ansari, S. A., Sattar, S. A., Springthorpe, V. S., Wells, G. A., & Tostowaryk, W. (1988). Rotavirus survival on human hands and transfer of infectious virus to animate and nonporous inanimate surfaces. Journal of Clinical Microbiology, 26, 1513–1518. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Azrin, N. H. (1977). A strategy for applied research: Learning based but outcome oriented. American Psychologist, 33, 140–149. [Google Scholar]
  5. Babcock, R., Sulzer-Azaroff, B., Sanderson, M., & Scibek, J. (1992) Increasing nurses’ use of feedback to promote infection control practices in a head injury treatment center. Journal of Applied Behavior Analysis, 25, 621–627. [DOI] [PMC free article] [PubMed]
  6. Berry, T. D., Geller, E. S., Calef, R. S., & Calef, R. S. (1992). Moderating effects of social assistance on verbal interventions to promote safety belt use: An analysis of weak plys. Environment and Behavior, 24, 653–669. [Google Scholar]
  7. Berry, T. D., Gilmore, M., & Geller, T. D. (1994). An individual-subject approach to the study of community-based interventions. Environment and Behavior, 26, 451–476. [Google Scholar]
  8. Bloomfield, S. F., Aiello, A. E., Cookson, B., O’Boyle, C., & Larson E. L. (2007). The effectiveness of hand hygiene procedures, including handwashing and alcohol-based hand sanitizers, in reducing the risks of infections in home and community settings. American Journal of Infection Control, 35 (10), 27–64.
  9. Boyce, J. M., & Pittet, D. (2002, October 25). Guideline for hand hygiene in health-care settings: Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Retrieved from https://doi.org/www.cdc.gov/MMWR/preview/mmwrhtml/rr5116a1.htm [DOI] [PubMed]
  10. Bryan, J. L., Cohran, J., & Larson, E. L. (1995). Hand washing: A ritual revisited. Infection and Control in Critical Care, 7 (4), 617–625. [PubMed]
  11. Centers for Disease Control and Prevention. (1987). Universal precautions for prevention of transmission of HIV and other bloodborne infections. Fact Sheet. Retrieved from https://doi.org/www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html
  12. Centers for Disease Control and Prevention. (2010, August 24). Norovirus: Technical fact sheet. Retrieved from https://doi.org/www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-factsheet.htm
  13. Centers for Disease Control and Prevention. (2011). Handwashing: Clean hands save lives. Retrieved from https://doi.org/www.cdc.gov/handwashing/
  14. Chaudhury, H., Mahmood, A. & Valente, M. (2005). Advantages and disadvantages of single vs. double occupancy patient rooms in acute care environments: A review and analysis of the literature. Environment and Behavior, 37(6), 760–786. [Google Scholar]
  15. Columbine, A., & Wharrad, H. (2007). Using computer technology to deliver an infection control update on hand hygiene. British Journal of Infection Control, 8 (3), 14 – 19.
  16. Dyer, D. L., Gerenratch, K. B., & Wadhams, P. S. (1998). Testing a new alcohol-free hand sanitizer to combat infection. AORN Journal, 68 (2), 239–251. [DOI] [PubMed]
  17. Geller, E. S., Eason, S., Phillips, J., & Pierson, M. (1980). Interventions to improve sanitation during food preparation. Journal of Organizational Behavior Management, 2, 229–240. [Google Scholar]
  18. Geller, E. S., Farris, J. C., & Post, D. S. (1973). Prompting consumer behaviors for pollution control. Journal of Applied Behavior Analysis, 6, 345–353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Jenner, E. A., Watson, P. W. B., Miller, L., Jones, F., & Scott, G. M. (2002). Explaining hand hygiene practice: An extended application of the theory of planned behavior. Psychology, Health & Medicine, 7 (3), 311–326. doi: 10.1080/13548500220139412 [Google Scholar]
  20. Johnson, H. D., Sholcosky, D., Gabello, K., Ragni, R., & Ogonosky, N. (2003). Sex differences in public restroom handwashing behavior associated with visual behavior prompts. Perceptual and Motor Skills, 97 (3), 805–810. [DOI] [PubMed]
  21. Kaplan, L. M., & McGuckin, M. (1986). Increasing handwashing compliance with more accessible sinks. Infection Control, 7 (8), 408–410. [DOI] [PubMed]
  22. Stephens, S. D., & Ludwig, T. D. (2005). Improving anesthesia nurse compliance with universal precautions using group goals and public feedback. Journal of Organizational Behavior Management, 25(2), 37–71. [Google Scholar]
  23. Luke, M., & Alavosius, M. P. (2011). Adherence with universal precautions after immediate, personalized performance feedback. Journal of Applied Behavior Analysis, 44 (4), 967–971. [DOI] [PMC free article] [PubMed]
  24. Malott, R. W. (1988). Rule-governed behavior and behavioral anthropology. The Behavior Analyst, 11(2), 181–204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Malott, R. W. (1989). The achievement of evasive goals: Control by rules describing contingencies that are not direct acting. In S. C. Hayes (Eds.), Rule-governed behavior: Cognitions, contingencies, and instructional control (pp. 269–322). New York: Plenum Press. [Google Scholar]
  26. Surgeoner, B. V., Chapman, B. J., & Powell, D. A. (2009). University students’ hand hygiene practice during a gastrointestinal outbreak in residence: What they say they DO and what they actually do. Journal of Environmental Health, 72(2), 24–28. Retrieved from https://doi.org/www.ncbi.nlm.nih.gov/pubmed/19761005 [PubMed] [Google Scholar]
  27. Turner, R. B. (1998). The common cold. Pediatric Annals, 27 (12), 790–795. [DOI] [PubMed] [Google Scholar]
  28. Venkatesh, A. K., Pallin, D. J., Kayden, S., & Schuur, J. D. (2011). Predictors of hand hygiene in the emergency department. Infection Control and Hospital Epidemiology, 32 (11), 1120–1123. [DOI] [PubMed]
  29. Voss, A., & Widmer, A. F. (1997). No time for handwashing, can we achieve 100% compliance? Infection Control of Hospital Epidemiology, 18 (3), 205–208. [DOI] [PubMed]
  30. Widmer A. F. (2000). Replace hand washing with use of a waterless alcohol hand rub? Clinical Infectious Diseases, 31 (1), 36–43. [DOI] [PubMed] [Google Scholar]
  31. Williams, M., Thyer, B. A., Bailey, J. S., & Harrison, D. F. (1989). Promoting safety-belt use with the traffic signs and prompters. Journal of Applied Behavior Analysis, 22, 71–76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Willis, J. (1995). Skin care: Principles of hand-washing. Nursing Times, 91 (44), 43–44. [PubMed]
  33. White, C., Kolbe, R., Carlson, R., Lipson, N., Dolan, M., Yusuf, A., & Cline, M. (2003). The effect of hand hygiene on illness rate among students in university residence halls. American Journal of Infectious Control, 31(6), 364–370. doi: 10.1177/0013916511408069 [DOI] [PubMed] [Google Scholar]

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