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Common Sense Isn’t Common

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by John Austin in Behavior change, Leadership, Safety

For years we’ve seen and posted the signs in the restrooms: “Employees must wash hands before returning to work”, and before March of 2020, the thought of your employees not washing his or her hands (while repulsive) didn’t strike fear into your heart quite like it does now.

A new study published in the Journal of Applied Behavior Analysis by Gravina, Nastasi, Sleiman, Matey and Simmons suggests that…

Proper hand hygiene consistent with CDC guidelines, is one of the most important preventative measures impacting disease transmission..

This doesn’t feel like a breakthrough statement, in fact most of us would consider it common sense… but like my dad always said… “Common sense isn’t common.”

While the COVID pandemic has put hand washing at the forefront of everyone’s minds, we can’t just assume a sign stating the obvious will evoke compliance, actually the research shows that those signs have little to no impact.

Think about it, if your mom had hung that sign in your bathroom when you were a kid, would that have changed your behavior?  I remember my mom doing a hand check before dinner and sending me back to go wash-up before eating (“…with SOAP!” she would yell as I hurried off to appease her demands.)

This has become a much more serious subject recently and with good reason.

Individuals who do not comply with proper hand hygiene procedures can transfer harmful pathogens to food items, fomites (e.g., objects or materials such as doorknobs), and other people, thus increasing the risk of spreading infectious diseases such as pneumonia, influenza, and COVID-19 (CDC, 2020b; Freeman et al., 2014).

Previous research suggests that there is poor hand hygiene compliance across industries, including those involving healthcare professionals, food workers, and human service employees (Bowman et al., 2019; Erasmus et al., 2010; Green et al., 2006).

For example, a review of hand hygiene compliance among healthcare workers found a median compliance rate of 40% (Erasmus et al., 2010). Similarly, research conducted with food workers indicated that they were only compliant with hand hygiene procedures during 26% of observed opportunities (i.e., before food preparation, after coughing, sneezing, or using a tissue; Green et al., 2006). Bowman et al. (2019) reported that handwashing adherence averaged 11% during baseline in a large human service organization.

Only 11% – 40%! Those stats are alarmingly low for my comfort level.

Since proper handwashing or use of hand sanitizer can effectively reduce the presence of germs and pathogens, improving hand hygiene compliance in the workplace may be paramount in preventing the spread of infectious diseases.

Although the practice of washing one’s hands after using the restroom or before meals is an established social norm in most cultures, some employees may not engage in the proper hand hygiene procedures described by the CDC and organizational guidelines because they have not been taught the relevant relations between hand washing and health consequences.

Employers might consider integrating hand hygiene procedures into work schedules by instituting policies that require all employees to wash or sanitize their hands upon entering or exiting the workplace, or during other occasions where transmission is more likely to occur.

These policies could also offer additional opportunities to measure hand hygiene compliance (e.g., use of hand sanitizer in a public area after entering or going to the bathroom to wash their hands).

However, mere exposure to verbal instructions about hand hygiene is not sufficient to improve compliance and should be combined with additional environmental strategies.

What does this tell us about hand hygiene and human behavior?

That, just like with everything else, we’ve got to create the right environment for the desired outcome, and collect some data to see if what we’re doing is working or not.

If you’d like to learn more about how your leaders can encourage these and other critical behaviors in your own organization, comment below or contact me here.



Centers for Disease Control and Prevention (2020b). Handwashing: Clean hands save lives.

Bowman, L. G., Hardesty, S. L., Sigurdsson, S. O., McIvor, M., Orchowitz, P. M., Wagner, L. L., & Hagopian, L. P. (2019). Utilizing group-based contingencies to increase hand washing in a large human service setting. Behavior Analysis in Practice, 12(3), 600-611.

Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., & van Beeck, Ed F. (2010). Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control & Hospital Epidemiology, 31(3), 283-294.

Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J. P. T., Wolf, J., Prüss-Ustün, A., Bonjour, S., Hunter, P. R., Fewtrell, L., & Curtis, V. (2014). Systematic review: Hygiene and health: Systematic review of handwashing practices worldwide and update of health effects. Tropical Medicine & International Health, 19 (8), 906-916.

Green, L. R., Selman, C. A., Radke, V., Ripley, D.,Mack, J. C., Reimann, D. W., Stigger, T., Motsinger, M., & Bushnell, L. (2006). Food worker hand washing practices: An observation study. Journal of Food Protection, 69(10), 2417-2423.

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