Non-Compliance and Hospital Acquired Infection: Using Design Methodologies to Improve Hand Hygiene Practices

Mr Kieran John1, Professor Mark Armstrong1

1Monash University, Caulfield East, Australia


There is an understood correlation between poor hand hygiene and hospital acquired infection (HAI) (Al-Tawfiq & Pittet, 2013). Evidence indicates the global cost of HAI is between $35.745B (Scott, 2009) and the WHO estimates there are 80,000 deaths per year attributable to HAI (WHO, 2017). Nevertheless, it is difficult to trace infection transmission back to poor hand hygiene practices by specific individuals. This lack of direct risk relationship makes enforcing hand hygiene an acute compliance issue.


This paper describes an ongoing research project led by Monash University Health Collab, a design research lab working across the medical and healthcare industry, in collaboration with a large Australian hospital and Enware, a manufacturer providing taps to hospitals. The research works to reduce HAI by improving hand hygiene practices, using design thinking and co-design methodologies. Using systems evaluation and empathy research with individual end-users, it identified failings of current procedures and motivations behind non-compliance.

 Results and conclusion:

While causation for sub-optimal hand hygiene is complex, a foundational problem is mindset and how it directs human behaviour. This research introduces the findings of a non-conventional, collaborative research project using design to improve mindsets and human behaviour to facilitate compliance, including forthcoming interventions and testing.


Kieran John (MBA, BID (hons)) is currently a Project Officer in design and research with a focus on design for health and medtech at Monash University. His research covers a wide range of areas including mental health, vision, pain management, surgery and infection control in healthcare.