“OMG THAT IS DISGUSTING!”: HARNESSING THE POWER OF REVULSION IN TEACHING INFECTION CONTROL AND HAND WASHING TO NEW RADIOGRAPHY STUDENTS

Control of infection is paramount in all healthcare settings, The National Institute for Heath and Care Excellence (NICE) have the following as one of their quality statements for infection control:

“People receive healthcare from healthcare workers who decontaminate their hands immediately before and after every episode of direct contact or care.” (NICE 2014)

When introducing students to the clinical environment for the first time, educators need to overcome the low compliance and lack of success of public education programmes that was noted by Wilson et al in 2011. Rothschild 1999 notes in his article on marketing strategy in health and social issue behaviours that people will act primarily out of self interest when it comes to public health issues, responding to a reward or positive outcome for themselves. Also by presenting the students with a social dilemma (Dawes 1980) where they are inconvenienced by an act but benefit society as a whole there may be more success.

As there is no immediate reward for the student when washing their hands this can present a problem, and the immediate social effects of hand washing are not always evident due to the microscopic nature of contaminants. The aim of our teaching was to make this reward and social effect as evident as possible to the students.

The use of glitterbug (TM) lotion has been recognised in its use in training on hand washing (Helms et al 2010) and this was used for the basis of the session. While normally used to show the effectiveness of hand washing techniques the team decided to take a bit more practical approach to its usage. The work was undertaken with groups of students on their visit to the university clinical skills x-ray room located in a busy teaching hospital. This is part of an active imaging department.

Firstly students applied the gel to their hands before getting changed into their uniforms. They were then asked to go into the x-ray room, put their bags and coats in a safe place and begin moving equipment, changing exposures and tidying the room ready for use. A portable UV light source was then used to show them the gel on their hands and then to conduct a survey of the room highlighting areas which had been touched. These areas not only included the equipment, but also demonstrated how the gel had transferred to bags, coats, water bottles, their uniforms and in some cases other areas of their own bodies.

Students then went to wash their hands appropriately and were reassessed after with the UV light to demonstrate the areas that had been missed. The light was also used to highlight the issues in the sink area where the gel had transferred to taps, soap dispensers and had also splashed during the hand washing process.

The student reaction was noted and recorded in the review of the sessions and the overall reaction was of disgust and fear and the ease of infection spread. It was noted that their reaction was very much in keeping with those highlighted in the work by Rothschild, that self interest and the social dilemma produced a positive result in the student attitudes to hand and environmental hygiene in the clinical setting.