Beyond a certain threshold, the amount of hand hygiene events by healthcare workers may be affected more by the location of hand rub dispensers than by the number of dispensers, according to a study in Infection Control and Hospital Epidemiology.
From April 2009 to October 2009, researchers increased the number of alcohol-based hand rub dispensers in different locations within a 10-room inpatient medical unit at a teaching hospital. The number of hand hygiene events was captured by electronic counters inside the dispensers.
At baseline, there were 13 hand rub dispensers: one immediately inside the doorway of each room and three in the hallway in high-use nursing areas. After 35 days, 10 hallway dispensers were added, which boosted the number of hand hygiene events per patient per day 26 percent, from an average of 31 to an average of 39. Over the course of the remaining five months, the researchers gradually increased the number of dispensers to 51.
After the initial addition of 10 hallway dispensers, the number of hand hygiene events per patient per day increased or decreased five times, ending with an average of 38. This leveling off suggests that beyond a certain point, which the researchers estimated at approximately two dispensers per patient in the study unit, the addition of dispensers does not increase the number of times healthcare workers use the hand rub. The authors suggested that after this threshold, placement of the hand rub dispensers may affect use more than their number does.
In the end, there were 21 dispensers in the hallway and three dispensers in each room — one just inside the doorway, one by the end of the bed and one outside the bathroom. Overall, 56 percent of hand hygiene events occurred in the hallway and 44 percent in the room. When the maximum 51 dispensers were in place, 63 percent of hand hygiene events occurred in the hallway and 37 percent in the room.
Within the room, 75 percent of hand hygiene events involved the dispenser inside the doorway, 19 percent involved the dispenser near the end of the bed and 6 percent involved the dispenser by the bathroom, according to the study.
The authors noted that the specific threshold for the number of dispensers may vary according to the specific unit.
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