Public Handwashing Facilities. I have an idea… How about we make handwashing a very public activity. Put the wash-basins, water, soap and drying facilities in a very public space, so that everyone can see what’s going on?

There’s the obvious impact of peer pressure that might come into play here, but I can also see other potential benefits:

• Group singing. A chance for people to sing along (with others) to the lyrics of their favourite song using the modified WHO hand washing guidance posters that have appeared (my favourite at the end of the post). *Caveat – no Justin Beiber allowed.
• For ‘literary types’. A chance to recite Shakespeare. In particular the Lady Macbeth, ‘out dammed spot’ part mentioned in the previous post (link here). Helpful if you are a bit ‘guilt ridden’.
• Influencing opportunities. A chance to stand next to the Chief Executive and purposefully share your thoughts and good ideas whist rubbing your hands gleefully (you can just imaging the people that will queue up for that opportunity in some places…).
• Gossip. Yep, we know it happens – maybe it will contribute to a more transparent workplace if we ‘share’ in public?
• What I actually meant to say instead of ‘Gossip’ was, Social Exchange of Knowledge. In reality this is the sort of social setting where most information is shared in organisations. Another ‘water-cooler’ opportunity.

There’s probably a million reasons why this is a stupid suggestion – but I’m not worried. I’ve got you here for my real reason – an explanation of the challenges of spreading good practice. I’d like to illustrate this through the lens of two handwashing pioneers from the late 1800’s; Florence Nightingale and Ignaz Semmelweis. Anyone still there?

Florence Nightingale knew her stuff. An 1860 quote from Florence Nightingale that featured in ‘Notes on Nursing, What It Is and Is Not’.

“Every nurse should be careful to wash her hands very frequently during the day. If her face too, so much the better. To wash with soap, and soft water…”

Behind this quote is a body of evidence that Florence Nightingale gathered to prove the effectiveness of cleanliness and good hygiene. This was a critical factor in the survival and recovery of injured British Soldiers fighting the Crimean War.

This article by Juli Maxworthy in Reflections on Nursing Leadership – The dirty hands of health care: What would Florence think?’ provides a useful summary of what Florence did in the 1850’s. It also provides a frightening insight into the impact of not washing hands in current times. It makes the link between poor hand hygiene and research into Hospital Acquired Infections and the preventable deaths each year of up to 90,000 hospital patients in the USA. Florence might have something to say about that…

The work of Florence Nightingale was clearly based upon sound observations and had evidence to back it up. You’d think it would be easy to change practice based upon this. It turns out not. Here’s a link to a post about the Coxcomb diagram she developed as part of her campaign to get the point across – an early example of an Infographic if you like.

Many people rejected her conclusions and it required the use of political connections to get things taken seriously. In the background to this was the ‘influence’ of reporters being present on the battlefield and the threat to share her findings with the general public if a Commission to review public health was not created.

Florence Nightingale got things done, but it does illustrate that clear evidence of good practice often isn’t enough to convince people. But, she did fare better than Ignaz Semmelweis who was trying to promote the benefits of hand washing a few years earlier.

The Bleak Tale of Ignaz Semmelweis. I don’t quite know where to start on this story. Basically, Semmelweis ‘the saviour of mothers’ was a doctor working in Vienna in the 1840’s. He noticed that the incidence of fever (infection) and death could be reduced significantly on maternity wards if the medical staff washed their hands. This was particularly evident if they washed their hands between working on postmortems and then delivering babies is the maternity ward.

This seems very obvious now, but at the time the ‘Germ Theory’ of how disease is spread hadn’t been proposed. Semmelweis was very much going against the common understanding and suffered for it. You can have a read about what Semmelweis went through to promote hand washing here or look at this excellent video by Micheal Loughlin from Nottingham Trent University.

If you want to know just how much Semmelweis suffered to spread good practice about handwashing, it doesn’t make comfortable reading. The ‘saviour of mothers’ was ‘shunned’ by the medical community, suffered with his mental health and died at the age of 47 in a mental health institution, from blood poisoning.

Good practice is not always common practice. The examples from Florence Nightingale and Ignaz Semmelweis in the late 1800s’ provide very important lessons for now. Being an innovator and having clear evidence of good practice does not necessarily mean an idea will be accepted by your peers and the top level decision makers in the organisations you work with. It’s tough changing embedded ‘custom’and practice.

Even if you did convince your peers (and the decision makers), there’s still the tricky challenge of changing the behaviour of practitioners, patients and the wider public.

The current emphasis on improving hand-washing practice would suggest that many of the previous ‘communications campaigns’ and other initiatives have failed to turn good practice into common practice. It’s far more complicated (and difficult) than just telling people what’s good for them. There’s a few suggestions in this post about ‘why good practice is such a bad traveller’.

Maybe we should try a bit of group singing at the communal public handwashing facilities?

So, What’s the PONT?

1. Washing your hands and the reduction in illness has been known for over 150 years.
2. Having solid scientific evidence of good practice doesn’t guarantee that people will listen to you, and do what you recommend.
3. The ‘ways and means’ of convincing people to adopt good practice or ‘do the right thing’ are complicated and require more than just ‘telling’ people what is good for them.

How about a sing along to this one? Rush, Spirit of Radio works surprisingly well. I can’t quite see it as a group activity though.

Source: washyourlyrics.com developed by William @neoncloth

Image Source: Florence Nightingale & Ignaz Semmelweis – public domain via Wikipedia.