Hand hygiene practice in hospitals is unfortunately still widely insufficient, even though it is known that transmitting pathogens via hands is the leading cause of healthcare-associated
infections. Previous research has shown that improving knowledge, providing feedback on past behaviour and targeting social norms are promising approaches to improve hand
hygiene practices. The present field experiment was designed to direct people on when to perform hand hygiene and prevent forgetfulness. This intervention is the first to examine the effect of inducing injunctive social norms via an emoticon-based feedback system on hand hygiene behaviour. Electronic monitoring and feedback devices were installed in hospital
patient rooms on top of hand-rub dispensers, next to the doorway, for a period of 17 weeks. In the emoticon condition, screens at the devices activated whenever a person entered or
exited the room. Before using the alcohol-based hand-rub dispenser, a frowny face was displayed, indicating that hand hygiene should be performed. If the dispenser was subsequently used, this picture changed to a smiley face to positively reinforce the correct behaviour. Hand hygiene behaviour in the emoticon rooms significantly outperformed the behaviour in three other tested conditions. The strong effect in this field experiment indicates that activating injunctive norms may be a promising approach to improve hand hygiene behaviour. Theoretical and practical implications of these findings are discussed.

• Quantitative data - Quantitative data were used during the intervention

• Human - All activities regarding organisations and individuals involved in health products and services

• Healthcare delivery