Dr. Elaine Larson, professor emerita of nursing research and professor emerita of epidemiology at Columbia University, who is considered one of the world’s leading authorities on hand hygiene, agrees. In 1980, Dr. Larson wrote her dissertation on hand-washing and devoted the subsequent 40 years to studying infection prevention and spreading the message that “clean hands save lives.”
“I don’t think that people are reluctant, but every decision we make occurs because of habit as well as a quick, unconscious risk-benefit assessment, and then we ‘decide’ that we are safe,” she says. “Most people from childhood ‘learn’ that they can often omit hand hygiene with no consequences, so that reinforces that it is not an essential habit.”
But even in times like these, she says it’s “difficult to link the cause — not washing — and the effect — getting sick — when there is a time lag between the two and when it does not occur 100 percent of the time.” Another obstacle to normalizing hand-washing is what psychologists call “optimism bias,” which leads many of us to believe bad things are more likely to happen to others.
So is there any hope of convincing people that an ounce of prevention is worth a pound of cure, especially when it comes to Covid-19? Does hand-washing stand a chance of becoming part of the new normal, like wearing seatbelts did once we fully realized their impact on saving lives?
Dr. Larson explains that it’s always easier to change a system than to change behavior. “Cars now beep to remind us of wearing seatbelts. In hospitals, we are testing ways to notify staff when they need to wash, but those systems still need a lot of work,” she says. “Something like that may happen eventually in, for example, public restrooms and airports.”
In 2009, the London School of Hygiene & Tropical Medicine studied the impact of intervention messaging in public bathrooms at rest areas along highways in England. Out of 14 different messages, “Is the person next to you washing their hands?” proved to be the most effective at changing behavior. So if we all start washing our hands more, others may be more likely to follow.
I followed up with my old friend Kelly Dineen, now a clinical psychologist with a private practice in Chicago, for her take on the situation. She suggested that those who remain indifferent or resistant to the cause should hang notes in their bathrooms and around the house to establish and cultivate the habit.