Use of an Innovative Game To Teach and Reinforce Hand Hygiene Compliance among Healthcare Workers

Abstract

BACKGROUND/OBJECTIVES: Hand hygiene (HH) is the most important method for prevention of infection transmission in healthcare. However, compliance with this simple technique continues to be sub-optimal. The purpose of this study was to evaluate the use of a novel game called SPLAT! to teach healthcare workers about the indications for HH, and to promote HH compliance. METHODS: This study was conducted in four intensive care units (ICUs) of an academic medical center in New York City. ICUs were randomized to play as multi-disciplinary teams or individuals. Indications for HH were printed onto business cards and given to all players. Players received stickers with their team color or random colors for the units with individual players. Players were instructed to observe others in the course of their day, and to SPLAT! them by placing a sticker on their shirt when they failed to perform HH as indicated on the card. Players in teams were told to remind teammates who failed to perform HH with no consequence, and to SPLAT! members of the opposing team for failure to perform HH. Each round of the game lasted for one shift. HH observations were conducted before and after SPLAT! to measure rates of compliance. Staff completed evaluations about the acceptability of SPLAT! as an educational tool. RESULTS: SPLAT! was played a total of 6 times. Three rounds were played on days, and three on nights. HH compliance rose significantly from 37% before SPLAT! to 52% (p = 0.025) overall after staff played SPLAT! This included significant increases in 3 of the 4 individual participating ICUs. Staff members' comments on evaluations indicated that playing this game successfully focused their attention on HH compliance. CONCLUSIONS: This study explored an innovative method for teaching healthcare workers about the indications for HH and the frequency with which it is required. The materials needed to play SPLAT! are simple, making it feasible for most healthcare settings. SPLAT! was accepted by most healthcare workers. Comments from players pointed to a unique aspect of SPLAT! in highlighting the multiple times that HH is indicated, and the activities of care in which HH is frequently missed. HH compliance is a complex behavior that is difficult to improve. SPLAT! helped to increase compliance in this study, possibly by illustrating the multiple indications for HH in every day practice. This study was supported by an unrestricted educational grant. GOJO Industries