By: Kyle Foerst, M.S., Emergency Response Planner, Saint Louis County Department of Public Health

Seasonal influenza occurs annually and can cause mild to severe illness, which can lead to hospitalizations and even death. Certain groups, such as elderly people, young children, and people with health conditions like heart disease, asthma, or weakened immune systems have a higher risk for serious flu complications. In Saint Louis County, between September 2015 and May 2016, there were 2,291 confirmed cases of influenza reported via sentinel surveillance of hospital emergency departments, urgent care centers, and pediatric departments. Of these cases, 29% were people 25 to 49 years, 16% were 50 to 64 years 15% were people 5 to 14 years and, 11% were people 2 to 4 years.

According to the CDC, the most effective way to prevent flu is to get a flu vaccination each year. However, everyday common preventive measures, such as frequent handwashing and covering your mouth when you cough, help prevent the spread of germs that cause influenza.

Just in time for National Health Education Week, last Saturday’s Global Handwashing Day and, of course, the month’s culminating All Hallows’ Eve, one local health department used all three as key ingredients to benefit the community they serve. In an effort to increase community awareness and educate on the role of proper hand-washing as an effective intervention to prevent disease transmission, the Saint Louis County Department of Public Health (SLCDPH) took a unique approach to improve community education and awareness with their “Dirty Hands can be Scary!” campaign. An educational outreach initiative designed to increase hand-washing practices throughout the Saint Louis region.

Designed primarily as a visual-based campaign, aiming first and foremost as a community outreach effort to inform and protect the local community against the upcoming flu season by purposeful placement of print graphics in key locations frequented by at-risk populations. The campaign also offers value to public health agencies and partners outside of the health department’s immediate service area through a campaign microsite.

Community Outreach Methods
The campaign’s main outreach method consisted of contacting local agencies and businesses within SLCDPH’s jurisdictions. By soliciting guidance from the local community, the campaign chose to target travelers as its main audience due to a higher likelihood of common exposure to diseases while visiting other locations. As a result, the main locations selected to display campaign imagery were businesses associated with higher levels of out-of-town visitors (e.g. airports, trains, hotels, bus stations, etc).

To execute the key messaging behind the campaign’s intended behavior, SLCDPH utilized graphic design to illustrate the “scariness” of dirty hands. Through means of available grant funding, SLCDPH submitted a request for proposals (RFP) and received several competing offers for graphic design work. After a formal review process examining each perspective bidder’s experience, graphic design quality, and fiscal proposal, the Saint Louis University’s Heartland Center for Public Health Preparedness was officially sub-contracted to design a set of eight graphics. The final four campaign visuals are pictured above.

Subsequently, SLCDPH collaborated with local transit organizations including MetroLink, the mass transit authority for the greater Saint Louis area, and Lambert-Saint Louis International Airport. Their negotiations resulted in the following advertisement options:

• Lambert-Saint Louis International Airport agreed to display 4 backlit dioramas, sized 62”W x 43”H, plus one 70” LCD display near the entrance to the Metrolink train station.
• MetroLink Transportation, which includes both buses, and trains, agreed to provide 8 buses, 4 bus shelters, 4 windscreens, and 4 train displays.
• Internal MetroLink displays agreed to include 400 “bus cards” (above the driver), sized 17×11; and 150 “Rider Alerts” (ad portrait next to train doors), sized 11×17.

In addition to the campaign’s focus on transit facilities, SLCDPH saw an opportunity to update current hand hygiene materials used in medical facilities, schools, businesses, and daycares. Many resources seem to have become mundane, failing to capture the attention of the public and effectively change behavioral practices that increase the spread of disease.

Current efforts include reaching out to over 20 school districts within Saint Louis County and Saint Louis City to inform them of the upcoming campaign, and encourage distribution of the campaign graphics to schools within each district. To encourage participation of school administration while addressing potential cost barriers, SLCDPH is mailing an 11×17 copy of each advertisement on cardstock paper for the use of each school. Furthermore, SLCDPH has provided full-sized high-resolution images for further distribution among schools, or personal/business use. These are available for download on the campaign microsite.

Campaign Microsite (Website)
While the print advertisements were designed to captivate community attention, SLCDPH aimed to also generate usage of a newly created a campaign microsite as a one-stop source on the topic of hand hygiene. This website aims to inform local residents, the general public, SLCDPH and other public health partners –including education institutions, medical facilities and local businesses – about illnesses (respiratory, foodborne, and travel-related) and infections that can be prevented or reduced by proper hand washing.

Additionally, the site includes recommendations for proper hand-washing procedures related to duration and key times to wash, resource videos for hand-washing instruction, and a form site visitors can use to request campaign posters.

More Information
Whether in the Saint Louis area or not, local health departments and partners are highly encouraged to use the materials developed through this campaign and spread the word about the importance of hand hygiene as a key preventive method to the flu and other illnesses! Start by visiting the campaign microsite and direct any questions or inquiries regarding the campaign to Kyle Foerst.