While preparing an article on the spread of superbugs, I was struck by similarities with our response to climate change.
Superbugs travel mainly on the hands of healthcare workers (HCWs) who fail to wash them adequately between patients. Correct hand hygiene is considered to be the single most important means of preventing cross-infection. But HCWs, who are trained in hand hygiene and taught the consequences of non-compliance, just don’t get around to doing it often enough.
Where this has parallels with climate change is that researchers believe the key to improving hand washing habits lies in the psychology of behaviour change. This notion, described in more detail below, could extend to our attitudes to lifestyles when considering the threat to our planet. We are being asked to switch from our well-worn ways to a new and costly path, but this doesn’t suit us and so we don’t.
The reluctance surrounding hand hygiene has defeated efforts to overcome common objections, such as abrasive soaps, uncomfortable towels and too few sinks. Even where these problems are addressed the barriers appear to be deep-seated in the mind, hence the foray into psychology.
But the research in this field is arcane and difficult to follow. You have to grapple with terms like “cognitive dissonance”, referring to an erroneous rationalisation of poor hand hygiene by HCWs arguing that the patient will benefit from the time saved. “Unrealistic optimism” points to a belief that infection is so unlikely, HCWs don’t believe they can ever be perpetrators.There are also psychological models to get to grips with.
The “Theory of Planned Behaviour” was used by Elizabeth Jenner, principal lecturer in infection control at the University of Hertfordshire, to determine the factors that might predict a HCW’s intention to wash their hands. The Australian specialist Michael Whitby divided hand washing behaviour into two types, one employed when hands are obviously sticky or dirty, and the other carried out automatically after, erm, certain functions. Jenner examined healthcare poster messages to find out which are the most effective at reminging HCWs of their obligations – the ones that instil fear or those emphasising the benefits.
I don’t know whether anyone has applied this type of psychology to climate change behaviour. It has certainly been used on other aspects of health, for instance in persuading people to use suntan lotion. But the topic of superbugs has features in common with climate change that distinguish it from other health issues: it represents an invisible and apparently far-off threat. An infection developed by a patient has no more likelihood of being linked to a particular instance of poor hand washing than a flood in a developing country with an individual motorist in the privileged west.
Furthermore, as Jenner points out, HCWs do not directly benefit from their own hand washing. She has shown that the losses in terms of time and damage to skin outweigh the gains to healthcare professionals. Lifestyle changes inspired by a concern for the climate, such as giving up the car or the plane, are similarly chosen at a cost to oneself.
Jenner argues that an element of altruism will be needed if hand hygiene is to catch on as it should. Whitby suggests teaching very young children that washing their hands is about protecting others as well as themselves. The sooner we realise that the same approach should apply to climate change, the better off we will be. If no one is individually to blame, we are nevertheless all responsible and everyone must act.
Sadly the New Scientist didn’t want the hand hygiene article, for which I blame the curse of the psychobabble. Yet the World Health Organisation endorses the psychological approach o the global challenge of poor hand hygiene. It goes further: its guidelines booklet released in 2006 highlights the role of religion in this very personal human activity. The authors point out that some faiths encourage ritual hand washing while raise objections to clinical cleaning products because of animal or alcohol components. Buddhists favour clockwise movements and for Hindus, the left hand is dirty and fit only for cleansing oneself. Cue a whole new field of research into religion, superbugs and hands.
If the researchers involved were asked to advise climate changers, they would probably say there are no magic answers. Good hand hygiene examples set by senior clinical staff must be allied to state-of-the-art facilities and, in the opinion of some, a reduced workload on nurses who bear the brunt of patient care. A carrot-and-stick approach is advocated by Paul Elliott, senior lecturer in nursing and infection control at Canterbury Christ Church University. He proposes regular personal development sessions, during which HCWs can discuss the details of their work in a non-threatening environment, and greater disciplinary powers for infection control staff to deal with non-compliance.
And what of climate change? Solutions emerging from the grassroots include ecoteams to discuss one’s carbon footprint, information days and reminders in offices to switch off appliances and turn the heating down. These are countless tiny gestures whose cumulative effects cannot be calculated. But the real answers will have to come from above: redesigning our transport system, radical though it is, would be but a first step in a profound reorientation of our economy away from its dependence on oil. Climate change, like superbugs, may be with us for a while yet.
