The Power of Voice: Why Verbal Reminders So Effectively Improve Hand Hygiene

Most healthcare technologies  use alarms to signal a need to take action. But busy healthcare providers, overwhelmed by the ubiquity of alarms in clinical settings, quickly learn to adjust their attention and often ignore the alarms. Alarm fatigue occurs when healthcare workers who are exposed to a large number of frequent alarms become desensitized to the alerts. 

Alarms Aren’t as Helpful as You Think

The unintentional harms of alarms have been well-documented in recent decades. The U.S. Food and Drug Administration Manufacturer and User Facility Device Experience reporting system received 566 reports of patient deaths related to monitoring device alarms between 2005 and 2008, and found that alarm fatigue was a major contributor to many of these deaths.

As startling as it is to realize that clinicians may be slow to respond to potentially critical alarms, their actions aren’t surprising, given that 72-99% of clinical alarms are false. Additional research has found that “humans tend to respond to alarms in the same proportion to their perceived reliability of the alarm system.” As stated in a BMJ Open Quality article, “If alarms are 90% true, people will respond to them about 90% of the time, and if the alarms are 10% true, these alarms will be responded to about 10% of the time.” 

Characteristics of an Ideal Alarm 

In an effort to improve healthcare and save human lives, researchers and safety experts have worked to identify the characteristics of an ideal alarm – one that would quickly catch peoples’ attention and drive them to prompt, appropriate action. A 2006 article in the British Journal of Anesthesia lists 4 characteristics of ideal alarms:

  1. Easy to localize
  2. Resistant to masking by other sounds (the alarms “stands out” amid environmental noise)
  3. Allows communication
  4. Easy to learn and retain

Typical buzzing, beeping, or flashing alarms don’t meet many of these criteria. The sound or sight is not necessarily easy to localize, and these alarms all too quickly become a “normal” part of the environment. Buzzing sounds, beeps and flashing lights also don’t make clear the desired course of action.

A 2019 report from the National Fire Protection Research Foundation notes that alerts intended to drive human behavior are only successful if they:

  1. Grab attention
  2. Provide information
  3. Are deemed trust-worthy
  4. Clearly communicate what behavior is expected

The report indicates that verbal messages are particularly useful because they can provide information regarding what individuals should do in response to the alarm. Other studies support the utility of verbal alarms. At least one study found that people can learn the meaning of speech-based alarms more quickly than abstract alarms or auditory icons. 

Human Beings are Attuned to Human Voices

Humans are wired to respond to human voices. Infants may learn to recognize their mother’s voice while still in the womb, and babies prefer human voices to other sounds. 

In 2016, researchers working to improve astronaut response time to critical alarms found that people responded an average of 5 seconds quicker to speech alarms that sound tones. Recognizing that “in high-stress situation[s], it can be difficult to remember” what particular sounds mean, researchers concluded that installing a voice alert system on the International Space Station may improve safety. 

A 2021 study that compared human responses to audiobook narration by human and synthetic, technologically-created voices, found that people paid more attention and remembered more information when they heard human voices. 

Real-Time Voice Reminder Linked to Real-World Gains

The number one reason healthcare providers don’t perform hand hygiene is that they forget. It is exceptionally rare that a provider ever intentionally chooses to not perform hand hygiene. At the end of the day, all providers are people and they understandably spend most of their brain power focused on patient care, not constantly thinking about hand hygiene. 

In order to actually improve hand hygiene, healthcare providers need feedback to help them recognize their missed opportunities while they are focused on patient care. Will yet another alarm be effective in changing this poor hand hygiene behavior? 

Funnily enough, an early prototype sensor that we introduced had a beeper and flashing light. The technology worked, but all the clinicians ignored it. It was just another beep among the thousands that occur in healthcare every day. The SwipeSense system today uses a Real-Time Voice Reminder instead of bells, whistles, buzzing noises or flashing lights. The system is preprogrammed with a real person’s voice that can be customized to say, “please sanitize” when a provider fails to clean their hands. When the voice reminder is turned on, hospitals consistently see that hand hygiene performance more than doubles, on average – and healthcare associated infections (HAIs) decrease by over 65%. 

There’s a clear link between voice reminders and clinician behavior, as hospitals that have turned off the Natural Language Voice Reminder experience a return to baseline levels of hand hygiene within three to six weeks. When the reminder is turned back on, hand hygiene performance once again improves and HAIs decrease. 

Our team has also observed that personalized messages may be even more effective in improving hand hygiene performance. Many hospitals will make a recording of their hand hygiene slogan that has been a part of their education and culture. Some hospital with many international team members even utilize reminders in a variety of languages

If you’re serious about improving hand hygiene, voice reminders can help you cut through the noise.