"Priming" hand hygiene compliance in clinical environments

Dominic King, Ivo Vlaev, Ruth Everett-Thomas, Maureen Fitzpatrick, Ara Darzi, David J. Birnbach

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Introduction: Effective hand hygiene is the single most important procedure in preventing hospitalacquired infections. Traditional information/education-based interventions have shown only modest benefits on compliance. This study set out to investigate whether priming via olfactory and visual cues influences hand hygiene compliance. Method: Randomized controlled trial set in a surgical intensive care unit (SICU) at a teaching hospital in Miami, Florida. The primary outcome data involved observations-a mix of health professionals and service users were observed entering the SICU by 2 trained observers and their hand hygiene compliance was independently verified. Interventions included either an olfactory prime (clean, citrus smell) or visual prime (male or female eyes). The primary outcome measure was hand hygiene compliance (HHC) measured by the visitor using the hand gel dispenser. Results: At a 5% level there was significant evidence that a clean, citrus smell significantly improves HHC (46.9% vs. 15.0%, p =.0001). Compared to the control group, a significant improvement in HHC was seen when a picture of "male eyes" was placed over the hand gel dispenser (33.3% vs. 15.0%, p <.038). No significant improvement in HHC was seen when a picture of female eyes was placed over the same hand gel dispenser (10.0% vs. 15.0%, p =.626). Conclusions: This is one of the first studies to demonstrate that priming can influence HHC in a clinical setting. The findings suggest that priming interventions could be used to change other behaviors relevant to public health.

Original languageEnglish (US)
Pages (from-to)96-101
Number of pages6
JournalHealth Psychology
Issue number1
StatePublished - Jan 1 2016


  • Behavior change
  • Hand hygiene
  • Nudge
  • Priming

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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