Hand disinfection in the entrance area of hospitals: the infrastructure is critical

It’s not only hospital staff that contributes to patient safety through careful hand hygiene – visitors play an important role in infection protection.

Early in their training, doctors and nursing staff are made aware of the enormous importance of hand disinfection in patient care. Approximately one third of all nosocomial infections are considered preventable. The majority of these infections are preventable by practicing proper hand hygiene. However, studies show that this is practically not always feasible. On a normal day, more than 200 indications per patient for hygienic hand disinfection can occur in an intensive care unit. Assuming a care key of 1:2, the staff would have to spend an extra hour simply disinfecting the hands.

Easy access increases compliance among hospital visitors

Health care staff are typically very aware of the importance of hand hygiene, however the visitors at the hospital may not be as mindful. Usually on-site to assist patients during their stay in hospital, visitors also carry pathogens on their skin, which makes them an important component in keeping infections at bay. Some medical institutions use posters and stickers to encourage relatives to maintain hand hygiene when entering or leaving the ward. However, study results show that not even one percent of hospital visitors disinfect their hands. [1] Unlike the medical staff, visitors rarely come into contact with the patient’s mucous membranes, but can transmit pathogens to the patient’s body and environment, which in turn can potentially increase the risk of infection.

An important building block for improving compliance among hospital visitors is the easy accessibility of hand disinfectant dispensers. Especially in highly frequented areas, conspicuously placed dispenser systems can represent a significant added value for infection protection. A research team led by David Birnbach found that the installation of free-standing disinfection columns in entrance areas increases the compliance of visitors with hand hygiene to almost ten percent. [2] An even better result was achieved by an additional sign as a reminder of hand disinfection near the dispenser.

In contrast, by installing a desktop dispenser at the security counter in the same facility, only 0.67 percent compliance was achieved. A study by Mary Hobbs and colleagues also found that visitors are five times more likely to disinfect their hands if a hygiene dispenser is centrally located in the entrance area and easily accessible. [3]

Strikingly hygienic

The involvement of hospital visitors concerning hand hygiene is important and should be “part of the puzzle” of a comprehensive, holistic program to improve patient protection. The installation of eye-catching disinfectant dispensers, especially in the entrance areas of clinics and hospitals, has a positive effect on compliance among visitors. Motivating messages or icons on the hygiene dispenser additionally support the effect. The Christophorus clinics in Coesfeld experimented by printing a smiley face on a disinfectant dispenser in the entrance area of a hygiene-sensitive ward. As a result, hand hygiene compliance among visitors, staff and patients since the end of 2018 has seen notable improvement.

1 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

2 Birnbach, David J., et al. „Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby.“ American journal of infection control 40.4 (2012): 340-343.

3 Hobbs, M. A., Robinson, S., Neyens, D. M., & Steed, C. (2016). Visitor characteristics and alcohol-based hand sanitizer dispenser locations at the hospital entrance: Effect on visitor use rates. American journal of infection control, 44(3), 258-262.