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One nudge for hand hygiene
  1. Donald A Redelmeier1,
  2. Richard H Thaler2
  1. 1 Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Booth School of Business, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Donald A Redelmeier, Medicine, University of Toronto, Toronto, ON M5S, Canada; dar{at}ices.on.ca

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What are the new findings?

  • A behavioural nudge can be especially effective and durable if based on sludge reduction, defined as lowering a barrier that discourages people from doing the right thing.

  • We introduced a simple label to encourage people to report an empty hand sanitizer dispenser located in public places inside a large acute care hospital.

  • We later checked 100 dispensers inside the hospital and found only 2 empty (notified and refilled promptly).

  • A similar check of 100 dispensers at a nearby hospital found 11 empty (no readily apparent way to notify for refilling).

How might it impact on healthcare in the future?

  • Other hospitals could immediately adopt this nudge to strengthen the connection between intentions and actions for hand hygiene.

  • Crowdsourcing provides a practical method to support hand hygiene by allowing outpatients, families, visitors, staff, volunteers and others to notify hospital services about empty hand sanitizer dispensers that requires refilling.

Background

The COVID-19 pandemic has caused over a 100 million cases and substantial numbers of admissions to acute care hospitals. Hand hygiene is a practical, affordable, acceptable, safe, reliable and effective strategy to mitigate the risks of nosocomial transmission to other patients in hospital for other reasons. Hand hygiene is also critical for ensuring the safety of healthcare workers and maintaining overall hospital staffing. However, hand hygiene is fallible because of many cognitive biases in everyday care.1 Clinicians, for example, have no easy way to determine if they are contaminated, whether their hand hygiene is sufficient, or if they are recalling correctly a repetitive activity.2–4

One strategy for improving hand hygiene is to increase the availability of hand sanitizer dispensers in public places is to structure more convenient opportunities for repeated hand washing. Each dispenser installation requires no electricity, plumbing or batteries and can be retrofitted onto existing infrastructure quickly and cheaply (figure 1). The logistics mostly require finding a wall …

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Footnotes

  • Contributors Both authors contributed to the design, analysis and interpretation of the findings. The first author (DAR) wrote the first draft. Both authors approved the final submitted version.

  • Funding This project was supported by the Canada Research Chair in Medical Decision Sciences and the Canadian Institutes of Health Research.

  • Competing interests None declared.

  • Author note Crowdsourcing provides a practical method to support hand hygiene by allowing outpatients, families, visitors, staff, volunteers and other to notify hospital support services about empty hand sanitizer dispensers that requires refilling.

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