The infection control community loves colour codes. Why shouldn’t they? You can label a patient room with a blue sticker to show that the patient in there is currently under isolation for a gruesome antibiotic-resistant bug. You can print out a standard hand hygiene notice to post on the entrance to a screening room, the pink photocopy paper it’s printed on communicating to cleaners to be extra careful when disinfecting. It’s quick and inexpensive, and to those in on the code it’s quite handy.
This is the main issue we have with them. Colour codes only work if everybody in that hospital is, in fact, in on the code – which of course is not the case. Patients are not in on the code as they are, well, sick. Visitors (who outnumber patients two to one on some days) are not in on the code either. Housekeeping staff filling in at a different hospital or campus may not be in on the code as two hospitals are not guaranteed to use the same codes. Hospital administration staff or contractors may not be in on the code either for many similar reasons, or they simply could be having a bad day and forgot. These codes are therefore stunningly exclusive rather than inclusive.
We’ve made the case for inclusiveness in infection control communications on multiple occasions. Put simply, a very small percentage of people at risk of either getting or passing on an infection are in on the colour codes. That means that there are large swaths of people who are simply prone to pass on infection.
Have you ever heard of miscommunications when transferring patients between hospitals? Of food services staff entering isolated patient rooms accidentally without donning protection? Of visitors doing the same? It happens all the time, which costs the health system loads and loads of money in treating hospital-acquired infections.
How can we fix this?
Let’s take a look at the field of branding and marketing. Marketing language refers to the relative inclusiveness as a “target audience.” If we are to advance these communications from the exclusiveness of a cryptic colour code we need to set our “target audience” net a tad wider than “infection prevention practitioners” and “hospital cleaning staff.” We need to include the general public, who don’t have the luxury of studying a legend before entering a hospital. How do we do that?
Through symbols and symbolic colour usage, that’s how.
Focus on what’s important – the message. The colour chosen should be bright and obvious but it should have a meaning of its own that echoes (therefore strengthening!) the message of the symbol.
Our Stop: Clean Your Hands sign that we use as a Twitter avatar uses red as its only colour. To someone who is not colour blind, the red reinforces the word “STOP.” To someone who is, it doesn’t make a difference as the message is still passed on by the text, the illustration, and even the shape of the symbol. It’s designed so that nobody can misinterpret it. We’ve got many more examples freely downloadable in our Infection Control Symbol Package, which can be found here.
Not to say that colour codes are all bad! There’s one in particular that, in the West at least, is stunningly well-known and effective at changing behaviour: the “traffic signal” colours. Green for healthy (or ‘go!’), yellow for caution and red for stop are useful, meaningful colours that can bolster meanings in symbols or by themselves. In fact, in at least one study they’ve been proven to work to change health behaviours in hospitals.
However – as with the traffic signals themselves, care must be taken regarding colour blindness. The red light is always first, giving a backup visual clue.
So the question to you – are you using communications such as colour codes that can be (or are) misinterpreted or missed entirely? If so, with antibiotic resistant organisms like MRSA or C. difficile making homes in our hospitals with alarming regularity, why do we continue to risk it?