“Targeting Hand Hygiene to increase the Public Health Resilience in The Norwegian Army”. A Quasi-experimental design

Abstract

Background Current security predictions are based on new non-linear hybrid threats with the potential to harm both military and civilian public health (PH). Inadequate hand hygiene practices may increase vulnerability unless resilience can be improved. Handwashing habits are difficult to change but are key to successful decontamination and maintenance of low risk (GREEN) zones the Norwegian Army’s operating environment. Medical intelligence, involvement in operational planning processes, and ‘nudging’ are interdisciplinary approaches suggested as ways forward to promote military and civilian PH. Materials and Methods With permission from the Norwegian Defence Force, data on hand hygiene was collected at two different locations. One unit (TMBN) was the exposed to an intervention briefing based on the principles of ‘nudging’, and the unit was observed after a one-week delay comparing pre- and post-intervention results. Collected data was explored for further research opportunities. Results The intervention significantly increased mean duration of handwashing with soap and water by almost 33%, and documented a significantly reduced frequency of those failing to wash hands adequately, but also of those making use of hand sanitisers after washing. There was no significant difference between officers and NCOs, or male and female soldiers. Assessment Much valuable PH research can be conducted within a military setting, increasing the ability of subject matter experts (SMEs) to influence the decision makers as well as the troops directly. Nudging can be a successful tool for this purpose but needs to be followed up by frequent reports of performance.