Close to the patient: Hand hygiene at the point of care

The availability of hand disinfectants in the immediate vicinity of the patient has a positive influence on compliance.

The five moments of hand hygiene are regarded as a milestone in infection prevention. This concept developed by the World Health Organization (WHO) summarizes countless individual indications for hygienic hand disinfection in five simplified groups. In the meantime, the model has become an integral part of every international and national guideline for infection prevention in medical facilities.

In the extended and direct patient environment the five moments are divided into two zones. The latter is particularly crucial. This is because the majority of all hand hygiene indications occur quasi directly at the patient and during his/her treatment – i.e. at the “point of care”. They can also be classified as more critical to infection due to aseptic activities or contacts with potentially infectious material, which is why careful hand hygiene is particularly important here. Numerous clinical studies confirm the positive effect of improved availability of hand disinfectants at the point of care on hygiene behavior and patient protection. As early as 2000, a scientific study showed that an increase in disinfectant dispensers and better accessibility during patient care can increase compliance from 23% to 48%.¹

Easy, fast and convenient to reach

The WHO has established this point as a core component of a multimodal strategy to improve hand hygiene behavior in its Recommendation on Hand Hygiene in Health Care. From the WHO’s point of view, it is important that hygiene dispensers in arm length can be reached during patient care. Medical staff often have to leave the immediate patient environment to find the nearest hygiene dispenser, which interrupts the workflow and has a negative effect on compliance. However, reaching for the smock pocket bottle is also less convenient in common practice and is also associated with an additional risk of contamination.

A comprehensive study carried out by Hansen and colleagues in 2015 shows that every third normal ward in Europe does not have a hand disinfectant available at the point-of-care and that safe patient care is therefore compromised in the long term. This is an unsatisfactory situation.²

Robust and safe at the point of action

Now the question arises, why is this equipment is not optimized? One of the main reasons is certainly the lack of possibilities for the hand hygiene product to be safely and permanently installed within the “point-of-care”. Simple wire baskets in which Euro bottles with screw-on dosing pumps are used, always offer a compromise, but are not an ideal solution since ergonomic operation is not perfectly feasible. This is because the pump design only allows direct hand contact and promotes microbial contamination of the pump head, which the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (KRINKO) clearly states as a “no-go” criterion in its recommendation on hand hygiene in health care facilities.³

The best approach are solutions that allow the installation of a complete hygiene dispenser with exchangeable dosing pump at the patient’s bed, dressing trolley or a device rail close to the patient. This guarantees hygienic and ergonomic operation at the point of care at all times. Non-contact dispenser systems support hygienic thinking and effectively prevent cross-contamination.

¹Bischoff, Werner E., et al. “Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic.” Archives of internal medicine 160.7 (2000): 1017-1021. Source.

²Hansen, Sonja, et al. “Provision and consumption of alcohol-based hand rubs in European hospitals.” Clinical Microbiology and Infection 21.12 (2015): 1047-1051. Source.

³Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Insitut “Händehygiene in Einrichtungen des Gesundheitswesens.” Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 9 (2016): 1189. Source.