A simple solution to avoid empty hand sanitizer dispensers

The COVID-19 pandemic has shone a spotlight on the importance of cleaning our hands repeatedly.

And while hand hygiene rates have improved considerably over the past year, hospitals have been presented a new challenge as they continue using more hand sanitizer than ever: how do we make sure hand sanitizer dispensers are refilled as soon as they’re empty?

Together with his colleagues, Dr. Donald Redelmeier, a staff physician in the division of general internal medicine at Sunnybrook Health Sciences Centre, has found a simple yet effective solution to keep the dispensers functioning, which is now published in BMJ Innovations.

“We placed a label on the hand sanitizer dispensers to encourage people to report an empty dispenser. It’s a simple behavioural nudge that encourages people to do the right thing, which means picking up a phone and requesting a refill,” says Dr. Redelmeier.

The label placed on the dispensers says, "If empty call 4555," which is the internal telephone number for the hospital’s Environmental Services office. On average, the office receives over a dozen such calls during an eight-hour shift from individuals reporting an empty dispenser including outpatients, families, visitors, staff, students and volunteers.

“We believe the label is a practical way for a hospital to use crowdsourcing to increase the reliability of hand hygiene,” says Dr. Redelmeier, who is also a senior scientist at the Sunnybrook Research Institute and a professor of medicine at the University of Toronto’s Temerty Faculty of Medicine.

Improving and maintaining the reliability of hand hygiene is vitally important at Sunnybrook, which has over 800 hand sanitizer dispensers. Busy locations may need to be refilled two to three times per day, whereas other locations might need a refill only two to three times per month.

After the labels were added to dispensers around the hospital, the research team sent a medical student to check 100 dispensers at Sunnybrook and found only two were empty. The student called, and both were refilled within the hour. In comparison, a similar check of 100 dispensers at a different hospital close to Sunnybrook found 11 empty, with no readily apparent way to contact anyone for refilling.

Dr. Redelmeier says this approach differs from past strategies to improve hand hygiene through posters or other reminders to promote behaviour. “More exhortation may not always lead to more hand hygiene since people already have plenty of awareness,” he says.

“This nudge is designed to target sludge, defined as elements of a process that discourage people from doing the right thing. A classic non-medical example of sludge is an awkward system hindering people from cancelling a magazine subscription they no longer need. Reducing sludge can be a distinctly effective, acceptable and lasting way to advance positive behaviour,” he adds.

“Other hospitals could immediately adopt this nudge of adding a label to hand sanitizer dispensers as a way to strengthen the connection between intentions and actions for hand hygiene.”

Media contact:
Sybil Millar, Communications Advisor
sybil.millar@sunnybrook.ca