Accessibility of sanitizer dispensers is a major influencing factor in whether hospital visitors disinfect their hands when entering and leaving the building. Researchers uncover the disparities in perceived and actual hand hygiene behaviour in a study across four German hospitals.
Thorough hand hygiene is a key element in infection prevention and control. In the wake of the COVID-19 pandemic, the awareness of effective infection control measures has increased in the general population. In the healthcare sector, hand hygiene has long been an integral part of medical staff’s everyday routine–though many studies have reaffirm the need for continued improvement. It is estimated that a large percentage of the more than 600,000 hospital-acquired infections that occur each year in Germany alone, could be prevented through more effective hand hygiene practices.
In addition to staff, hospital visitors also play a role when it comes to infection prevention. When a visitor goes to see their loved one in the hospital, they often come into close contact. In this context, germs can transmit quickly from the visitor to the patient. In cases where the patient is immunocompromised, passed infections can have dire consequences. Disinfecting their hands upon entering and leaving the building is a simple, yet effective measure hospital visitors can use to protect themselves and their loved ones. Unfortunately, this measure is not practiced frequently enough.
Extremely low hand hygiene compliance rate among hospital visitors
Existing literature reports hand hygiene compliance of less than one percent among hospital visitors.  This alarming figure reveals enormous potential for improvement.
In an effort to better understand visitors’ hand hygiene behaviour, a team of researchers conducted a study across four German hospitals. The researchers distributed a survey, including questions on whether visitors disinfect their hands when entering the facility, and what factors prevented the use of hand disinfectant dispensers within the hospitals.
Of the 1040 survey participants, 838 completed the open-ended response field with reference to dispenser use. The researchers then categorized these statements into three theoretical models.
Placement of sanitizer dispensers is crucial to stimulate use by hospital visitors
Results indicate that during observation, only about a quarter (26.6%) of visitors disinfected their hands upon entering the hospital. According to the survey results, more than 40% (42.4%) of respondents answered ‘yes’ to the question of whether they sanitized their hands upon entering the hospital. Comparable discrepancies between observed and perceived hand hygiene behaviour has also been found in other studies among hospital staff. 
According to the survey results, dispenser accessibility was one of the most frequently cited reasons for failure to sanitize hands in hospital entrances. Additionally, many respondents wrote that they simply did not think about disinfecting their hands upon entering the building. To address these issues, the researchers advocate that hospitals should position their dispenser systems in highly visible, easily accessible locations. By optimizing dispenser placement, visitors can form a better link in effectively preventing the spread of infections.
Placing dispensers at the forefront in hospital entrances
The Sigma Center in Bad Säckingen provides a successful example of how to effectively attract visitors’ attention to hand disinfection. Upon entering the clinic, visitors are greeted by a touchless, PRAESIDIO dispenser. The neon yellow dispenser cover instantly grabs visitors’ attention, with a message encouraging them to disinfect their hands. An additional sign on the opposite side of the entrance reminds and directs visitors to disinfect their hands upon entering and leaving the building.
A link to the study: https://www.ajicjournal.org/article/S0196-6553(21)00002-X/fulltext
 Pittz E.P., Availability and Use of Hand Hygiene Products, by Visitors, at the Entry Points of Hospitals American Journal of Infection Control 37 (5), 2009
 Kelcikova, Simona, et al. “Flawed self‐assessment in hand hygiene: A major contributor to infections in clinical practice?.” Journal of clinical nursing 28.11-12 (2019): 2265-2275.