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Nudge to deliver on UN Goal #3 of ensuring healthy lives and wellbeing for all

Many institutions are eager to contribute to realizing UN’s 17 Sustainable Development Goals. However, turning ambition and strategic goals into actions and everyday habits can be tricky - Here nudge led approach plays a crucial role

Case: Nudge to improving hygienic and safe lives

A large number of hospitalized patients are at high risk of being infected with one or more infections during their hospital stay. In the US alone, more than 200 people die every day as a result of healthcare-associated infections caused by poor hygiene in hospitals (e.g. hospital staff and visitors not washing their hands with soap). In developing countries, the number of fatalities caused b poor hospital hygiene is more than 4,000 per day, making good hygiene at hospitals a main target in most countries. Optimizing hospital hygiene is a matter of changing everyday behavior and habits for both staff, patients and visitors and holds a huge potential when it comes to saving lives and delivering on UN SDG #3

In a large size Danish hospital, Krukow was requested to optimize procedures related to hygiene for both Staff and visitors especially for high risk patients admitted into isolation wards.
Formel procedures described how especially staff was suppose to use hand sanitizer and wear approved PPE (personal protective equipment) when entering isolation wards. However, extensive observations and data collection showed that in only 16% of the time would staff follow formel procedure, which was putting both patients, visitor and staff at risk of spreading lethal infections.

The reason for the lack of correct hygiene procedures, had nothing to do with either a lack of education or motivation amongst staff, but was caused by basic human decision-making systems within the human brain.

Basically human decisions are either made on a subconscious- or a conscious level - through a 1) 'automatic' or 2) 'analytical' thought-system. The subconscious- and automatic decision making is based on instincts and the design of our surroundings, whereas conscious and analytical decision-making is based on information and knowledge. Unfortunately, 95-99% of everyday decisions are determined by the subconscious and automatic thought system. In a hospital setting, this means that despite of hospital staff being well educated, decisions of whether to use hand sanitizer or put on PPE before entering e.g. isolation wards, are determined on whether the surroundings succeed to nudge and remind staff in the right way at the right moment - in key decision moments e.g. just before entering isolation wards.

To optimize hand hygiene we redesigned especially entrance areas leading towards isolation wards, changing text heavy manual to visual guides, guiding to right habits of using hand sanitizer and PPE. Furthermore, we change placement of hand sanitizer dispensers and PPE, making it available and visible at entrance areas of isolation wards. Combining visual nudges with systemic changes in placement made better hand hygiene second nature and increased right hygiene procedures from 16% to 59%.

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