Can we save lives lost in hospitals around the world due to infections, by offering healthcare workers prizes to use hand sanitizer?

Hand hygiene is important in preventing diseases such as cold, seasonal flu, RSV and gastro-intestinal diseases, and now also COVID-19. According to Health Quality & Safety Commission New Zealand, up to 10% of hospital patients acquire an infection during their stay in hospital. Improving the hand hygiene compliance rate in hospitals is the best way of preventing many of these infections. In New Zealand, District Health Board staff hand hygiene compliance rate is close to 90%. With support from our Auckland International Campus (AIC), Principal Lecturer Farhad Mehdipour has been investigating how a new app, Ignaz, might help DHBs and other workplaces to increase staff hand hygiene.

The app gamifies hand sanitization and mask usage; participants have a chance to win a prize if they log their use of hand sanitizer or mask in the app. They can choose to participate by clicking in the app or using a voice command to activate it. The app then records a short video of the person. If the person wins, the video is checked only to verify the use of hand sanitizer or mask and identify the winner, then deleted. Videos of other participants are deleted without being viewed.

Dr Farzan Fallah is the founder and the CEO of US company Idelan Inc., which developed the Ignaz app:

“Ignaz works by offsetting the invincibility bias of people and creating an incentive for them to perform hygiene tasks. We think that just because something bad, such as infection, didn't happen to us before, it's not going to happen to us in the future. So we may skip using masks or hand sanitizer. We also have the tendency to overestimate our chance of winning a lottery, a jackpot or a prize drawing. We think we didn't win before, but we will be lucky and will win this time. This is the opposite of the invincibility bias and can offset it.”

In an experiment Farhad conducted in 2021 with ethics approval, he established baseline volumes of sanitizer use over a two week period, then emailed our AIC staff advising them of the project and inviting them to participate when using hand sanitizer. People could still use the sanitizer without participating in the app. The results showed that the gamification increased the volume of sanitizer use over a two week period up to 13 times the baseline.

In future phases of the project, Farhad would like to test the effectiveness of gamification as an incentive to increase hand hygiene compliance rate in hospitals, and to increase mask usage during flu season. 

March 2022