IMPROVING HAND HYGIENE IN CRUISE SHIP: AN INTERVENTION STUDY.

Background: Cruise ships are relatively small, crowded spaces where many people travel in a new environment, making infection control especially important. Proper hand hygiene is the first line of defense against the spread of infection. This study aimed to measure the effectiveness of different hand hygiene improvement measures onboard. Methods: The study took place on the Results: Each person onboard used on average 7.6 soap doses and 1.6 hand-rub doses per day, indicating suboptimal hand hygiene frequency. Surface disinfection sprays were not proven to effectively reduce microbial loads on surfaces. Staff members missed an average of 9.6% of hand surface during hand rubbing when hand hygiene was first monitored. Hand hygiene monitoring devices can only be effective if crew members can use them during their shifts. Designing hand hygiene training for crew members is challenging, as they have very limited preexisting knowledge of health sciences. Conclusions: Surface disinfection, technique monitoring, and passenger training did not improve hand hygiene in the forms applied in this study. Crew training improved theoretical knowledge, but we were not able to demonstrate any measurable behavioural change. There were some additional lessons from the study. Hand hygiene compliance is primarily determined by the setting-the placement of dispensers and whether passengers are reminded to use them. Language barriers are a limiting factor that should be considered when planning communication strategies for both crew and passengers. On cruise ships, hand hygiene is often associated with food hygiene. While there are clear recommendations in that area, there is a lack of guidelines on how to improve passengers' hand hygiene. Some passengers have strong opinions about hand hygiene-either positive or negative-but they are a minority. The majority of passengers are not interested on hand hygiene; they perform it when the setting is optimal but otherwise skip it. Clear recommendations are needed to establish an environment that effectively promotes hand hygiene.