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How the positioning of handrub dispensers affects passengers’ hand hygiene behavior
1
Department of Microsystems, University of South-Eastern Norway, Porsgrunn, Norway
Publication date: 2025-12-05
Corresponding author
Popul. Med. 2025;7(Supplement 1):A31
KEYWORDS
ABSTRACT
Introduction:
The COVID-19 pandemic underscored the importance of infection control on cruise ships. Hand hygiene is exceptionally effective for preventing the of infection transmission. Alcohol-based handrub makes hand hygiene feasible at any location. Adherence to hand hygiene practices is often unsatisfactory, even in healthcare1. Cruise ship passengers exhibit low compliance with hand hygiene, as they prioritize relaxation2. This study aims to determine how to improve passengers' compliance with hand hygiene.
Methods:
The study was conducted onboard the Celestyal Olympia. Hand hygiene compliance (how many times people clean hands/opportunities when they should) was measured by direct observation.
Results:
Compliance varied significantly; positioning of dispensers had the most substantial impact. During disembarkation, compliance was 26.4% when the dispensers were placed where people were waiting in line, compared to 0.7% when the dispensers were placed after the checkpoint, where passengers hurried to board the tender boat. During embarkation, compliance was 3.3% when the dispensers were positioned close to the desk where passengers had to show their boarding cards. When placed farther, compliance increased to 33.0%. At the restaurant, receptionist asked everyone to rub their hands, resulted 79.2% compliance. In the buffet, where the equipment was left unattended, compliance dropped to 7.5%.
Conclusions:
Several criteria were identified for better dispenser placement. Dispensers should be visible from a distance, allowing people time to process their presence. Should be placed along walking paths, as people are unlikely to take extra steps to reach them. People should not be in a hurry when they approach the dispenser. Their hands should be free; when they need to present their ship cards or tickets, they cannot use the dispensers. People should be reminded to use the dispensers. The study was conducted on a single cruise ship, that limits the generalizability of findings. Direct observation may introduce observer bias.
The COVID-19 pandemic underscored the importance of infection control on cruise ships. Hand hygiene is exceptionally effective for preventing the of infection transmission. Alcohol-based handrub makes hand hygiene feasible at any location. Adherence to hand hygiene practices is often unsatisfactory, even in healthcare1. Cruise ship passengers exhibit low compliance with hand hygiene, as they prioritize relaxation2. This study aims to determine how to improve passengers' compliance with hand hygiene.
Methods:
The study was conducted onboard the Celestyal Olympia. Hand hygiene compliance (how many times people clean hands/opportunities when they should) was measured by direct observation.
Results:
Compliance varied significantly; positioning of dispensers had the most substantial impact. During disembarkation, compliance was 26.4% when the dispensers were placed where people were waiting in line, compared to 0.7% when the dispensers were placed after the checkpoint, where passengers hurried to board the tender boat. During embarkation, compliance was 3.3% when the dispensers were positioned close to the desk where passengers had to show their boarding cards. When placed farther, compliance increased to 33.0%. At the restaurant, receptionist asked everyone to rub their hands, resulted 79.2% compliance. In the buffet, where the equipment was left unattended, compliance dropped to 7.5%.
Conclusions:
Several criteria were identified for better dispenser placement. Dispensers should be visible from a distance, allowing people time to process their presence. Should be placed along walking paths, as people are unlikely to take extra steps to reach them. People should not be in a hurry when they approach the dispenser. Their hands should be free; when they need to present their ship cards or tickets, they cannot use the dispensers. People should be reminded to use the dispensers. The study was conducted on a single cruise ship, that limits the generalizability of findings. Direct observation may introduce observer bias.
ACKNOWLEDGEMENTS
We thank the crew members of Celestial Olympia for supporting the study.
CONFLICTS OF INTEREST
None declared.
FUNDING
HEALTHY SAILING project has received funding from the European Union’s Horizon Europe Framework Programme (HORIZON) under Grant Agreement number 101069764. Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Climate, Infrastructure and Environment Executive Agency (CINEA). Neither the European Union nor the granting authority can be held responsible for them. This work was funded by UK Research and Innovation (UKRI) under the UK government’s Horizon Europe funding guarantee [grant number 10040786], [grant number 10040720]. This work has received funding from the Swiss State Secretariat for Education, Research and Innovation (SERI).
ETHICAL APPROVAL AND INFORMED CONSENT
The Research Ethics Committee of the University of Thessaly (Greece) approved the research project with the decision number is 59 / 19.09.2022. The project was also submitted to the Norwegian Medical Research Ethics Committee (REK), which determined that the project falls outside the scope of the Health Research Act (it should not consider as a clinical study) and does not require ethical approval (decision reference number 562942).
REFERENCES (2)
1.
World Health Organization. WHO Guidelines on hand hygiene in health care: First global patient safety challenge clean care is safer care. World Health Organization. 2009. Accessed July 2, 2025. https://iris.who.int/bitstream...
2.
Werder O, Holland K, Kiaos T, Ferson MJ. Between the sea and the sky: A social practice investigation into health behaviours during cruise travel. Health Promot J Austr. 2022;33(Suppl 1):367-378. doi:10.1002/hpja.593
| eISSN: | 2654-1459 |
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