The Importance of Hand Hygiene
Handwashing practices in the patient care setting have been recognized as critical to infection prevention since the early 19th century. Over the years, the evidence for the vast importance of proper hand hygiene has continued to mount, with studies demonstrating that it is one of the most effective ways to reduce the transmission of pathogens responsible for nosocomial or healthcare-associated infections (HAIs).
Contaminated hands of healthcare providers are a primary source of pathogen spread in healthcare settings. Proper hand hygiene decreases the proliferation of microorganisms, thereby reducing infection risk, healthcare costs, length of stays, and even impacting reimbursement. The Centers for Disease Control and Prevention (CDC) states that hand hygiene is the single most important practice in reducing the transmission of infection in healthcare settings.
Despite this clear evidence, studies have repeatedly shown that the importance of hand hygiene is not adequately recognized among healthcare professionals, and compliance remains low. This is an issue not just in clinical settings, but across the general public as well. “Understanding the importance of hand hygiene and its impact on the pathogenic spread of microorganisms is best understood when one understands the anatomy of the skin,” explains the CDC.
The skin serves as a protective barrier, containing both resident and transient flora – microorganisms that can be removed through proper handwashing, but that may cause infections if transferred to other areas of the body or to patients. Transient flora, in particular, is often acquired by healthcare workers through direct contact with patients or contaminated surfaces, and can be more easily removed through routine handwashing compared to resident flora.
Handwashing Guidelines and Techniques
The CDC and World Health Organization (WHO) have established clear guidelines for proper hand hygiene practices in healthcare and community settings. These include:
Indications for Handwashing:
– When hands are visibly soiled
– Before eating
– After using the restroom
– If potential exposure to Clostridium difficile, norovirus, or Bacillus anthracis
Handwashing Technique:
1. Wet hands with clean, running water (warm or cold), turn off the tap, and apply soap.
2. Lather hands by rubbing them together with the soap, making sure to scrub all surfaces of the hands, including palms, backs, fingers, and under the nails.
3. Continue scrubbing for at least 15-20 seconds.
4. Rinse hands well under clean, running water.
5. Dry hands using a clean towel or air dry them.
Alcohol-Based Hand Sanitizers:
Alcohol-based hand sanitizers are recommended when hands are not visibly soiled. Apply 3-5 mL of the product to the palm of the hand and rub hands together, covering all surfaces, until the hands are dry – about 20 seconds.
Handwashing with soap and water is required in cases of potential exposure to spore-forming pathogens like Clostridium difficile or Bacillus anthracis, as alcohol-based sanitizers are not reliably sporicidal. For surgical hand antisepsis, healthcare workers must follow a specific multi-step process using either antimicrobial soap or an alcohol-based hand rub.
The Need for Innovative Public Education
Despite the clear guidelines and evidence, hand hygiene compliance remains suboptimal, not just among healthcare workers, but in the general public as well. Experts agree that educational programs, ergonomic factors, and appropriate staffing ratios all play a critical role in improving hand hygiene adherence.
One innovative approach to improving hand hygiene practices is the development of serious game apps. Serious games combine the engaging and motivational elements of video games with educational content, providing an immersive learning experience. Research has shown that serious games can be an effective tool for changing health behaviors, including handwashing.
A study published in the Journal of Medical Internet Research in 2013 evaluated the use of a serious game app called “Clock Wash” to teach proper handwashing techniques. The app guided players through the WHO’s recommended 6-step handwashing procedure, providing feedback and scoring to reinforce learning.
The study found that players who used the “Clock Wash” app demonstrated significantly improved handwashing technique compared to a control group. Participants were able to correctly identify the appropriate duration and steps of handwashing, indicating that the game-based approach was an effective way to educate users on proper hand hygiene.
Designing an Evidence-Based Serious Game App
Building on the success of the “Clock Wash” app, public health experts and game designers can collaborate to create even more engaging and impactful serious game apps for handwashing education. Key design considerations include:
Grounding in Behavioral Science
Incorporating behavior change theories, such as the Theory of Planned Behavior or the Health Belief Model, can help ensure the game mechanics and content effectively motivate users to adopt proper handwashing habits.
Immersive Gameplay
Leveraging game elements like storytelling, challenges, feedback, and rewards can create a fun, engaging experience that keeps users motivated to learn and practice good hand hygiene.
Multimedia Approaches
Combining interactive tutorials, mini-games, and multimedia content (e.g., videos, animations) can reinforce key handwashing concepts through multiple sensory channels.
Personalized Experiences
Tailoring the game content and feedback to the user’s age, location, or health status can make the learning experience more relevant and impactful.
Multiplatform Accessibility
Developing the serious game app for both mobile and web-based platforms increases accessibility and reach among diverse audiences.
Integration with Public Health Campaigns
Aligning the app with broader handwashing promotion efforts, such as the CDC’s “Clean Hands Count” campaign, can amplify the educational impact.
Rigorous Evaluation
Conducting studies to assess the app’s effectiveness in improving handwashing knowledge, skills, and behaviors is crucial to validating the approach and guiding future iterations.
Conclusion
Handwashing is a simple, cost-effective intervention that can have a profound impact on public health by reducing the transmission of infectious diseases. However, despite clear guidelines and evidence, hand hygiene compliance remains suboptimal. Innovative approaches, such as serious game apps, offer a promising avenue to enhance handwashing education and drive behavior change.
By grounding the game design in behavioral science, creating immersive and personalized gameplay, and integrating the app with broader public health initiatives, developers can create an evidence-based serious game that effectively teaches proper handwashing techniques and motivates users to adopt good hand hygiene habits. Rigorous evaluation of these apps can further strengthen the evidence base and guide the development of even more impactful handwashing education tools.
Investing in the creation and dissemination of serious game apps for handwashing is a smart, cost-effective strategy to improve public health outcomes and reduce the burden of infectious diseases. As we continue to navigate the challenges of the COVID-19 pandemic and beyond, equipping the public with the knowledge and skills to maintain proper hand hygiene will be crucial for building resilient, healthy communities.
