Hand Hygiene campaign for Imperial College Healthcare NHS Trust

Two years before the covid pandemic we collaborated with clinicians, nurses and cleaning staff to reimagine hand hygiene messaging for hospital staff across five NHS hospital sites. The campaign achieved a doubling of awareness and hand cleaning rates.

No items found.
‘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‘


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

The cost of a single case of bloodstream infection


We were invited by epidemiologist Jon Otter at the Department of Infectious Diseases, Imperial College NHS Healthcare Trust (ICHT) 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. The campaign more than doubled awareness and hand hygiene rates from 31 to 68%. It continues to be used across the Trust.

What we did

We helped the NHS team develop a project brief using the inspiration of pop culture to create a range of playful and memorable signs. The signs needed to stand out within a busy, information-filled environment. They were designed to draw attention, encouraging nurses and other staff to use the gel dispensers by injecting a sense of fun into hand cleaning and making it less of a chore.

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 and which would provoke a response. The outcome was a playful combination of cheesy, modern and old school lyrics.

Why is design important?

Traditional hand hygiene systems are often inconspicuous, ugly, complicated or even aggressive and paternalistic. Toilets and hygiene equipment can often be the least cared for and least valued part of the 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.

Design can help us recognise the problems by framing the issue from a human as well as technical perspective and methods of participation and empathy can draw together ideas in a non-hierarchical environment that allows everyone to have their say.

Designers also have an eye for detail and a deep understanding of the material world, which can ensure that solutions are not only empathetic but also effective and efficient too.

’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 developed a comprehensive ‘how to’ guide to help busy staff install the system effectively so that it complemented the environment rather than creating clutter.

We managed the production of the campaign and liaised with the support team to ensure that everything was working well.

After the project launch, Anne gave a presentation with the hand hygiene team where we discussed the challenge of hand hygiene from a design perspective and have been pleased to hear positive feedback from other trusts as well as health care colleagues from as far afield as New Zealand.


Hand hygiene compliance improved from 31% to 68% on 10 focus wards


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.

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’.


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