Hand Hygiene campaign for Imperial College Healthcare NHS Trust

Just over a year before Covid-19 struck, we collaborated with clinical specialists, nurses and cleaning staff at Imperial College Healthcare NHS Trust to reimagine hand hygiene messaging for hospital staff across their five hospital sites. According to an audit carried out by the Trust, it achieved a doubling of awareness and hand cleaning rates.

Featured in Design Week's best studio project of the month

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‘In the UK, poor hand hygiene in hospitals affects more than 300,000 patients every year, resulting in 5,000 deaths and costing UK hospitals up to £1billion every year‘ (ref.)

We were invited by epidemiologist Jon Otter, then at the Department of Infectious Diseases, Imperial College NHS Healthcare Trust to support the design and delivery of a campaign to encourage hand washing by nursing staff across the Trust’s five London hospitals.

We co-designed a physical and digital campaign based around popular lyrics which was installed across he Trust’s 120 clinical areas. A project audit revealed that campaign more than doubled awareness and hand hygiene rates from 31 to 68%.

Total design and production costs across 300 hospital wards for our year long campaign

Cost of a single case of bloodstream infection
£35,100 (ref.)


We helped the NHS team develop a project brief using the inspiration of pop culture to create a range of playful and memorable signs. Our signs were designed to draw attention in a busy, information-filled environment while encouraging nurses and other staff to wash their hands by injecting a bit of fun and cheerfulness, making it less of a chore and perhaps to be done while humming a tune.

How we did it

We ran co-design sessions with nursing staff where we encouraged them to think about tunes and lyrics that they would recognise. The outcome was a playful combination of ‘cheesy’, modern and old school lyrics.

Hand hygiene signage is typically inconspicuous, ugly, complicated or even aggressive and paternalistic. Toilets and hygiene equipment can often be the least cared for parts of a hospital environment. Yet our hands are the main way that cross-infection happens and hand hygiene is the single most important factor in the control of infection.

’Staff can’t resist our new hand hygiene posters!’

– Imperial College Healthcare NHS Trust Quality Improvement

Photos of nurses using the dispensers and reacting to the signage were used in social media to spread the message. The Trust’s Quality Improvement team also ran events and set up ‘hand hygiene’ awareness stands that used the posters and stickers to get feedback and more ideas.

We managed the production of the campaign and liaised with the support team to ensure that everything was working well, which included developing this comprehensive ‘how to’ guide to help staff install the system effectively.

Audit results

The audit revealed that the campaign had a ‘marmite’ effect, with a split between those who loved it in and those who didn't like it at all! But staff unanimously agreed that it was impactful and it worked.

Observations took place between May 2018 and November 2019 and the quality improvement team continued to use and develop the system in response to internal feedback.

Hand hygiene compliance improved from 31% to 68% on 10 focus wards (ref.)

Compliance on 10 focus wards increased from 31% (154 of 489 observations) to 68% (355 of 517 observations) over three time points, with a 23% improvement in the first six months alone. Interestingly, the rate of improvement fell in the second half of the study showing the importance of constantly engaging with the community you are serving and ensuring that design doesn’t become redundant as the ‘cultural environment’. (ref.)

After the project launch, Design Science‘s Anne Odling-Smee was invited by project lead Jon Otter, now Director of Infection Prevention and Control at Guy's and St Thomas'​ NHS Foundation Trust, to present our project to the hand hygiene team at St Mary‘s Hospital alongside Professor Alison Holmes, Martin Kiernan and Darshan Patel.

It‘s been great to hear positive feedback from other NHS Trusts as well as non-UK based health care colleagues from as far afield as New Zealand.

Can we help you develop a health campaign and overcome a wicked healthcare challenge? Do get in touch

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