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Culture Change in Infection Control: Applying Psychological Principles to Improve Hand Hygiene

Cumbler, Ethan MD; Castillo, Leilani BSN, CNN, RN; Satorie, Laura BSN, RN; Ford, Deborah BSN, OCN, RN; Hagman, Jan MS, RN; Hodge, Therese COMT; Price, Lisa MD; Wald, Heidi MD, MSPH

Journal of Nursing Care Quality:
doi: 10.1097/NCQ.0b013e31829786be

Hand hygiene occurs at the intersection of habit and culture. Psychological and social principles, including operant conditioning and peer pressure of conforming social norms, facilitate behavior change. Participatory leadership and level hierarchies are needed for sustainable patient safety culture. Application of these principles progressively and significantly improved hand hygiene compared with the hospital aggregate control. Changes to hand hygiene auditing and response processes demonstrate ability to improve and sustain adherence rates within a clinical microsystem.

Author Information

University of Colorado School of Medicine, Anschutz Medical Campus, Aurora.

Correspondence: Ethan Cumbler, MD, Acute Care for the Elderly Services, University of Colorado Hospital, 12701 E 17th Ave, Mail Stop F782, Aurora, CO 80045 (

The authors thank Brian Bandle, Denise Alison, Bill Mramor, Marie Andrews, and Lindsay Klingman.

The authors declare no conflicts of interest.

Accepted for publication: April 17, 2013

Published online before print: May 10, 2013.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins