Research

Are wearable dispensers necessary?

Hand hygiene not influenced by wearable dispenser
Wearable dispenser for hand hygiene

Portable dispensers had no effect on hand hygiene compliance, when used in hospitals with adequate dispenser equipment.

A recently published Swiss study has found that portable dispensers do not improve observed hand hygiene compliance.

These tiny 100ml sanitizer bottles, which can be stored in the pockets of healthcare professionals, were thought to increase convenience and availability of hand sanitizer for healthcare workers. A study conducted at the Zurich University Hospital showed that, when an adequate amount of dispensers are present, the addition of these bottles had no effect on hand hygiene. Staff interviewed also raised concerns about contamination of the portable dispensers.

In its 2009 model “5 Moments of Hand Hygiene”, the World Health Organization defined five moments where hands should be disinfected in a healthcare setting. In order to comply with those five moments, it is imperative that healthcare providers have adequate access to alcohol-based sanitizers near their patients.

Robert Koch Institute sets standards for dispenser equipment

Clinics and hospitals generally use wall-mounted dispenser systems in order to achieve the “5 Moments of Hand Hygiene.” The Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (KRINKO), in its recommendations on hand hygiene in health care facilities, specifies exactly where and how many hygiene dispensers are to be provided “on the ward.” The Commission recommends one dispenser per patient bed as the minimum for intensive care and dialysis units. In regular patient care, one dispenser can be provided for two patient beds. Installing dispensers close to the patient has a decisive advantage – there is no additional walking for the healthcare worker, effectively increasing compliance and infection protection.

In some cases, medical facilities have relied on wearable dispensers. The portable dispenser systems are designed to ensure hand hygiene opportunities are available when wall-mounted dispensers are lacking. However, the extent to which the solution represents added value in the context of multimodal interventions to improve patient safety had not yet been investigated.

Wall-mounted dispensers eliminate the need for wearable dispensers

The Zurich University Hospital research team equipped the hospital staff in an emergency room with wearable dispensers, and trained the staff in the correct use of the small to-go sanitizer bottles. In addition, existing wall-mounted dosage dispensers and table-top devices were used to support hand hygiene on one unit. These included 34 dispensers in the immediate vicinity of the patient’s bed.

In addition to recording hand disinfectant consumption, the researchers distributed a questionnaire to the hospital staff to determine the subjective perception of the study participants in the practical handling of the portable bottles.

During the intervention phase of the study, 7.5 percent of the total disinfectant consumption was accounted for by the wearable dispensers. The team of scientists did not find any significant increase in consumption or observed compliance.

Obstacles: Ergonomics and design

The most frequently reported reason for the comparatively low frequency of use of mobile dispensing solutions was the awkward, cumbersome handling of the bottle itself. In addition, the doctors, nurses and medical staff interviewed expressed safety concerns regarding the possibility of microbial contamination of the bottle. As the portable dispenser was  in frequent contact with the bare hand, the surface is contaminated quickly, promoting the transmission of pathogens.

The large number of wall-mounted hand disinfectant dispensers already available also played a major role in the behaviour of staff. In particular, dispensers located very near patients offered staff more rapid product availability, without having to resort to the bottle.

It appears that with a sufficient equipment base of permanently installed, wall-mounted dispensers, the majority of hand disinfections can be carried out. In particular, the use of mounting solutions that bring dispensers closer to the patient have proven to be a critical compliance-promoting measure.

The use of smock wearable dispensers is to be regarded as sensible in facilities that are not well-equipped or spatially confined.

Ecological and economic aspects must also be taken into account when choosing wearable or permanent dispensers. Compared to standard 500 ml and 1,000 ml standard Euro bottles, the 100 ml bottle is more cost-intensive and only lasts a maximum of just over 30 hand infections. The KRINKO recommends not to refill the small bottles, and one-time use creates an additional burden on the environment.

Source: Quelle: Keller, J., Wolfensberger, A., Clack, L., Kuster, S. P., Dunic, M., Eis, D., Flammer, Y., Keller, D. I. & Sax, H. (2018). Do wearable alcohol-based handrub dispensers increase hand hygiene compliance?-a mixed-methods study. Antimicrobial Resistance & Infection Control, 7(1), 143.

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