摘要：We tested the efficacy of a simple, visual cue to increase hand washing with soap and water. Automated towel dispensers in 8 public bathrooms were set to present a towel either with or without activation by users. We set the 2 modes to operate alternately for 10 weeks. Wireless sensors were used to record entry into bathrooms. Towel and soap consumption rates were checked weekly. There were 97 351 hand-washing opportunities across all restrooms. Towel use was 22.6% higher ( P = .05) and soap use was 13.3% higher ( P = .003) when the dispenser presented the towel without user activation than when activation was required. Results showed that a visual cue can increase hand-washing compliance in public facilities. Promoting hand hygiene compliance is an ongoing public health effort. 1 Proper hand hygiene is among the most important measures for preventing and controlling microbial pathogen cross-transmission 2–4 and is a cost-effective intervention for the control of many infectious diseases. 5 The Centers for Disease Control and Prevention’s Cover Your Cough campaign advised people to use their upper sleeve or elbow, rather than a hand, to cover their mouth when they cough. 6,7 The Secretary of Health and Human Services notoriously chastised a reporter during a press conference for not following the guidelines. 8 More recently, the increased incidence of a vector resistant to alcohol gels, Clostridium difficile , in US hospitals has increased the importance of effective hand-washing behaviors. 9 Despite efforts to increase public awareness, hand hygiene compliance rates are difficult to influence and remain stubbornly low. 10 In particular, increasing hand-washing rates after the use of public restrooms has been challenging. 11,12 Interventions have been tested in numerous settings (e.g., schools and hospitals); however, no single intervention has produced consistent and lasting improvements in hand-washing rates. 3,13 Education, training, and behavior modification are often cited as important components of hand-washing compliance (HWC) programs. 11,14,15 However, interventions with only 1 component have not yielded significant gains in HWC, or the gains have been transitory, falling back to baseline levels over time. 13,14,16–18 Moreover, the effectiveness of education-centered interventions is primarily limited to the individuals targeted by the effort. 19 Research examining hand-washing interventions often lacks methodological rigor, limiting causal inferences. 13,20 Therefore, an ideal HWC intervention would be noninvasive and create sustained increases in HWC that could be statistically verified. The intervention would also be easily implemented as part of the existing hand-washing station equipment and provide a positively framed message to engage in the desired behavior. 4 Modifying towel dispensers to signal consumers is a behavioral cue that may have sustained impact on HWC rates, with concomitant benefits.
