Hand hygiene at a petting zoo; room for improvement

OK hockey player and erstwhile blogger about all things zoonotic, Scott Weese, published a pretty cool paper about handwashing at a petting zoo on Friday.

Weese and doctoral candidate Maureen Anderson used a variation of our video observation system to watch and code the hand hygiene behaviors of visitors to a petting zoo at the University of Guelph’s annual open house, known as College Royal (that’s in Canada).

Video observation with discrete cameras has a couple of advantages: actions can be repeatedly viewed to make sure they are coded correctly, and video reduces the weirdness when people notice someone stalking watching whether they wash hands, in a bathroom, kitchen, or petting zoo.

As Weese writes in his Worms and Germs blog, “overall hand hygiene compliance was 58%. That means 58% of people that came into the petting zoo washed their hands or used a hand sanitizer on the way out. (It doesn’t mean they all did it well, but they at least did something). In some ways, that number’s good, when you compare to our earlier petting zoo observation study, (or even to results of hand hygiene rates of physicians in some hospitals). However, for such a short-term activity where there is easy access to facilities to wash hands or use a hand sanitizer, there’s much room for improvement.

“During the petting zoo, a few thing were changed at defined times to see if they could improve hand hygiene rates. Two things resulted in increased hand hygiene compliance; a combination of people offering hand sanitizer and improving signs, and having people at the exit reminder people to wash their hands. This suggests that people need a reminder to wash their hands. Whether they don’t think about it, or can’t be bothered unless someone points it out, is unclear, but having people encourage hand hygiene is a good think to consider. It’s practical for short-term events like petting zoos at fairs and similar exhibits, but not as practical for permanent exhibits.”

And not so practical for food service, hospitals and elsewhere. However a combination of rapid, relevant, reliable and repeated information, coupled with handwashing hall monitors, may increase rates of hand hygiene compliance. But more about that later. Some of the handwashing signs used in the Anderson and Weese experiment are shown, above right.

The abstract for the paper is below.

Video observation of hand hygiene practices at a petting zoo and the impact of hand hygiene interventions
Epidemiology and Infection
M. E. C. Anderson and J. S. Weese
Petting zoos are popular attractions, but can also be associated with zoonotic disease outbreaks. Hand hygiene is critical to reducing disease risks; however, compliance can be poor. Video observation of petting zoo visitors was used to assess animal and environmental contact and hand hygiene compliance. Compliance was also compared over five hand hygiene intervention periods. Descriptive statistics and multivariable logistic regression were used for analysis. Overall hand hygiene compliance was 58% (340/583). Two interventions had a significant positive association with hand hygiene compliance [improved signage with offering hand sanitizer, odds ratio (OR) 3·38, P<0·001; verbal hand hygiene reminders, OR 1·73, P=0·037]. There is clearly a need to improve hand hygiene compliance at this and other animal exhibits. This preliminary study was the first to demonstrate a positive impact of a hand hygiene intervention at a petting zoo. The findings suggest that active, rather than passive, interventions are more effective for increasing compliance.