A nudge intervention to improve hand hygiene compliance in the hospital.

Hand hygiene among professionals plays a crucial role in preventing healthcare-associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.

Imageability effect on the functional brain activity during a naming to definition task.

Lexical competence includes both the ability to relate words to the external world as accessed through (mainly) visual perception (referential competence) and the ability to relate words to other words (inferential competence). We investigated the role of visual imagery in lexical inferential competence by using an auditory version of an inferential naming-to-definition task, in which visual imageability of both definitions and target words was manipulated. A visual imageability-related brain activity (bilateral posterior-parietal lobe and ventrotemporal cortex, including fusiform gyrus) was found during a "pure" inferential performance. The definition effect in high vs. low imageability contrast suggests that a visual-imagery strategy is spontaneously activated during the retrieval of a word from a high imageable definition; such an effect appears to be independent of whether the target word is high or low imageable. This contributes to the understanding of the neural correlates of semantic processing and the differential role of spontaneous visual imagery, depending on the semantic properties of the processed stimuli.