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How to get doctors to hand hygiene: nudge nudge


The Nudge Theory has been widely used to improve healthy behavior [1, 2] and works as an external cue to memory [3]. The Nudge Theory is based on behavioural economics models that has been applied to move communities towards rational targeted purchasing and ecological preferred behaviour patterns [1, 2]. Consumers have been nudged successfully towards lower electricity purchasing patterns through displays of their past and current purchasing pattern.


To engage medical staff towards improved hand hygiene compliance.


An automated hand hygiene surveillance system was installed in an Australian tertiary teaching hospital. The clinicians were taught to access a dashboard for daily compliance rates to be discussed at hand-over meetings and to use a seven-step approach that included nudging each other on the wards with “Doctor, take a moment”. Feedback from clinicians about nudging and rates on both wards from June 2014 to February 2015 were compared.


During the run-in period prior to introducing nudging the baseline compliance rate was 18% on ward C and 37% on ward D. Preliminary results indicated one ward has improved by 32 percentage points while compliance on ward C remained stable at 15%. Clinicians on ward D reported that they were comfortable working as a team to nudge each other towards a goal of improved daily compliance and it was fun. Conversely, ward C clinicians reported a discomfort with nudging each other and were observed to have a different ward culture than ward D. We will discuss the difference in the staff and leadership on the wards that may explain the opposing attitudes towards nudging.


Nudging daily compliance rates by nurses and doctors resulted in collegiality and developed a ‘team consciousness’ about improvement in compliance. Changing hand hygiene compliance must work with different organization cultures on wards for effective change management.

Disclosure of interest

A. Kwok Conflict with: Deb Australia, Debgroup UK provided the automated system to collect daily compliance rates. The authors declared have no other conflict of interests. , M.L. McLaws Conflict with: Deb Australia, Debgroup UK provided the automated system to collect daily compliance rates. The authors declared have no other conflicts of interest.


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Kwok, A., McLaws, ML. How to get doctors to hand hygiene: nudge nudge. Antimicrob Resist Infect Control 4 (Suppl 1), O51 (2015).

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