Article Text

Download PDFPDF

Original research
Incubator traffic light: the development of an alcohol-based hand rub dispenser system for neonatal incubators with visual feedback to improve hand hygiene compliance
  1. Ronald H J van Gils1,2,
  2. Onno K Helder2,3,4,
  3. Linda S G L Wauben2,5
  1. 1 Institute of Engineering & Applied Science, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
  2. 2 Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
  3. 3 Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia, Rotterdam, the Netherlands
  4. 4 Create4Care, Erasmus MC, Rotterdam, the Netherlands
  5. 5 Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, the Netherlands
  1. Correspondence to Ronald H J van Gils, Institute of Engineering & Applied Science, Rotterdam University of Applied Sciences, Postbus 25035, 3001HA Rotterdam, the Netherlands; r.h.j.van.gils{at}


Introduction Sustained high compliance with hand hygiene prior to patient contact in a neonatal intensive care unit (NICU) could reduce the spread of pathogens and incidence of bloodstream infections of preterm infants. These infections are associated with high mortality, morbidity and additional costs. Behaviour change interventions to promote hand hygiene, such as education, have only temporary beneficial effect on compliance. Our aim is to develop a technical intervention that supports a sustainable behaviour change for appropriate hand hygiene among NICU healthcare professionals.

Methods Students from different disciplines incrementally designed and evaluated solutions in co-creation with healthcare professionals of a NICU in a teaching hospital.

Results A prototype of the ‘Incubator Traffic Light’ system for neonatal incubators was developed, that is, a touchless alcohol-based hand rub (ABHR) dispenser with integrated colour display and incubator door sensor with lights. The system provides visual feedback to support healthcare professionals’ compliance with the prescribed 30 s drying time for ABHR. After 30 s, green lights indicate that the incubator doors may be opened. In the event that doors are opened without dispensing ABHR or earlier than 30 s, blinking orange lights and a display message urge the person to close the doors. The system documents compliance data in a web-based database.

Conclusions We developed a sophisticated technical intervention to support hand hygiene compliance. It is ready for clinical tests that should prove that the system contributes to sustainable hand hygiene compliance near neonatal incubators.

  • neonatal intensive care unit
  • hand hygiene compliance
  • behaviour change intervention
  • feedback system
  • participatory design

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors RHJvG and OKH were involved in the planning and execution of the study and writing the associated manuscript, including revision. LSGLW was involved in writing and revising the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.