Hand Hygiene campaign for Imperial College Healthcare NHS Trust

Doubling awareness and hand cleaning rates through design

“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

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, that was installed across the Trust’s 120 clinical areas. 

The campaign more than doubled awareness and hand hygiene rates from 31 to 68% and is still being used across the Trust. 

What we did

We helped the team develop a clear project brief and used the inspiration of pop culture to create a range of playful and memorable signs that stood out in a busy environment and encouraged nurses and other staff to notice the gel dispensers and make cleaning hands less of a chore.

How we did it

We ran co-design sessions with the nursing staff and encouraged them to think about tunes and words that other nurses would recognise and provoke a response. The posters combined cheesy, modern and old school lyrics that had a ‘marmite’ effect but stuck in everyone’s heads.

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 also 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.

We 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.

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/

Hand hygiene complianceimproved from 31% to 68% on 10 focus wards


Technical impact

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. The 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. 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’.


“Staff can’t resist our new Hand Hygiene posters!”
– Imperial College Healthcare NHS Trust Quality Improvement

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