The availability of hand sanitizer dispensers is a key factor in increasing hand hygiene compliance. Researchers have now investigated the state of dispenser provision in Swiss hospitals.
Thorough hand hygiene with alcohol-based sanitizer is known to be the single most important measure to effectively prevent healthcare-associated infections. However, hand sanitization prompts are often not properly followed in the everday, hectic atmosphere of hospitals.
Studies show that not even half of all necessary hand sanization is carried out—though there are clear differences between different roles and wards. [1]
In Germany alone, about 600,000 hospital-acquired infections occur yearly. [2] In neighboring Switzerland, 70,000 infections occur annually in connection with medical treatment. [3] Across the Atlantic, more than 200,000 Canadian patients get HAIs on a yearly basis. [4] In a single year, there are over 680,000 HAIs just from acute care hospitals in America. [5] Improved hand hygiene could prevent a significant proportion of these infections.
Providing sanitizer dispensers in the immediate vicinity of patients is essential for improving the hand hygiene situation in hospitals. This vicinity is also referred to as the point of care. These three elements are present at the point of care: patient, staff, and the treatment. Numerous studies have thoroughly explored the correlation between optimized dispenser equipment and improved hand hygiene compliance. [6,7] Acting on this scientific consensus, the World Health Organization (WHO) recommends providing hand sanitizer at the point-of-care. [8]
KRINKO minimum standards for number of disinfectant dispensers in hospitals
However, the WHO does not define exactly how many disinfectant dispensers should be planned per patient room or per patient bed. Nor does any other international guideline specify a standard.
Only the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (KRINKO) in Germany writes the following in its recommendation on hand hygiene in healthcare: “For patient rooms, depending on the number of patient beds, the minimum recommended equipment is one dispenser per patient bed in intensive care and dialysis units and one dispenser for every two patient beds in non-intensive care units and in the sanitary cell.” [9]
Robust data on what hospital wards actually provide is not widely available. But scientists from the University Hospitals of Basel (USB) and Zurich (USZ) are now shedding light on the situation. As part of a study, the research team led by Dr. Sabine Kuster looked specifically at how many hand disinfectant dispensers are used in Swiss hospitals and at which locations the dispensers are used.
Swiss hospital network involved in study
Questionnaires were distributed to 178 hospitals in Switzerland participating in the Swissnoso program for the “stocktaking” study. Swissnoso is the national center for infection prevention dedicated to reducing hospital-acquired infections and multidrug-resistant pathogens in Switzerland. In the program, participating hospitals can compare themselves with other healthcare facilities, for example, via anonymized benchmarking in terms of hand hygiene behavior.
In total, 110 of the 178 hospitals (62%) completed the questionnaire and reported their results back to the researchers. Two-thirds of the hospitals had more than 100 patient beds.
Patient room entrance most popular dispenser location
The first question asked where hand sanitizer dispensers are most commonly installed in the hospital. By far, the most frequently cited locations were the “patient room entrance” (84%) and “near the sink” (74%).
The all-important location at the point-of-care (i.e., in direct proximity to the patient) fared far worse. Twenty-eight percent of participating hospitals said they keep a disinfection dispenser within a “1-meter radius of the patient bed.” Just under a quarter of healthcare facilities rely on hygiene dispensers “directly at the patient bedside.” It is noteworthy that especially the large hospitals with more than 500 beds rely on point-of-care disinfectant dispensers more frequently than average.
A minority of hospitals, 14 in total, also use disinfectant dispensers in other areas, such as on a trolley or nursing work cart.
Number of hand disinfectant dispensers per bed
The researchers also asked how many disinfectant dispensers are actually used in hospitals. After evaluating questionnaires from all participating healthcare facilities, it appears that Swiss hospitals use an average of 2.4 wall-mounted hand sanitizer dispensers per patient bed.
The study also examined how extensively portable bottles for hand sanitization are distributed to hospital staff. The result: a quarter of participating facilities predominantly use the “pocket-sized” sanitizer dispenser. However, studies show that the use of pocketable bottles have no significant impact on hand hygiene compliance—at least for clinics that are already well equipped with wall-mounted disinfectant dispensers. The Swiss hospitals participating in this study are certainly neatly positioned, with an average of 2.4 dispensers per hospital bed.
Another interesting finding that emerges from the Swiss study data is that for the large hospitals with more than 500 patient beds, hand disinfectant consumption per patient day increases significantly with the average number of disinfectant dispensers per bed. However, this relationship was not found statistically for hospitals classified as small (less than 200 beds) and medium-sized (200-500 beds).
New minimum standard for sanitizer dispensers?
In view of the fact that, at least in Germany, the KRINKO defines an equipment level per patient bed of 0.5x disinfectant dispensers in normal wards and 1x disinfectant dispenser in intensive care units, the Swiss authors of this study classify the data collected as a basis for discussion in order to define a new minimum standard.
Attention should continue to be paid to the availability of hand sanitizer dispensers at the point-of-care in order to effectively embed hand disinfection into the workflow of hospital staff.
In addition to quantity, the quality of sanitizer dispenser positioning is another decisive factor for improving hand hygiene compliance in hospitals.
Study: Kuster, Sabine, et al. “Handrub dispensers per acute care hospital bed: a study to develop a new minimum standard.” Antimicrobial Resistance & Infection Control 10.1 (2021): 1-6.
Sources:
[1] Erasmus, Vicki, et al. “Systematic review of studies on compliance with hand hygiene guidelines in hospital care.” Infection control and hospital epidemiology 31.3 (2010): 283.
[2] Zacher, Benedikt, et al. “Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012.” Eurosurveillance 24.46 (2019).
[3] Bundesamt für Gesundheit (BAG). Nationale Strategie zur Überwachung, Verhütung und Bekämpfung von Spital- und Pflegeheiminfektionen (Strategie NOSO)
[4] Canada, Public Health Agency of. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 23 Oct. 2013, www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/chief-public-health-officer-report-on-state-public-health-canada-2013-infectious-disease-never-ending-threat/healthcare-associated-infections-due-diligence.html.
[5] “Data Portal.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Nov. 2020, www.cdc.gov/hai/data/portal/index.html.
[6] Cure, Laila, and Richard Van Enk. “Effect of hand sanitizer location on hand hygiene compliance.” American journal of infection control 43.9 (2015): 917-921.
[7] Giannitsioti, Efthymia, et al. “Does a bed rail system of alcohol-based handrub antiseptic improve compliance of health care workers with hand hygiene? Results from a pilot study.” American journal of infection control 37.2 (2009): 160-163.
[8] Pittet, Didier, et al. “The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations.” Infection Control & Hospital Epidemiology 30.7 (2009): 611-622.
[9] Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Insitut “Händehygiene in Einrichtungen des Gesundheitswesens.” Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 9 (2016): 1189.
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