Placement of Hand Sanitizer Dispensers Important For Staff Compliance

Laila Cure, Ph.D. Assistant Professor Dept. of Industrial and Manufacturing Engineering Wichita State Interview with:
Laila Cure, Ph.D.
Assistant Professor
Dept. of Industrial and Manufacturing Engineering
Wichita State University

Medical Research: What is the background for this study? What are the main findings?

Response: It is widely known that healthcare work, particularly inpatient care work, is mostly knowledge-based. Healthcare workers are constantly assessing the clinical state of their patients and making decisions that affect their workflow. This type of work is difficult to study and organize as a whole using traditional work design techniques, which are mostly designed for routine, repetitive work. Nevertheless, there are components of inpatient work that can be improved using basic workstation design principles. Hand hygiene is one of them.

Hand hygiene is still the single most important intervention to prevent infection in hospitals. Guidelines state that health care workers should clean their hands before touching a patient, before an aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings. Hand sanitizer dispensers are practical resources to support hand hygiene because they can be placed almost anywhere throughout hospital units. This study aimed at determining whether “good” placement of sanitizer dispensers correlates with compliance of staff in using the sanitizer. “Good placement” was defined in terms of usability characteristics extracted from hand hygiene literature recommendations. Of the usability characteristics included in the study, visibility and accessibility had some statistical influence on improving compliance.

Medical Research: What should clinicians and hospital managers take away from your report?

Response: From the point of view of the work system, the hand sanitizer is a resource needed during any type of inpatient care work that involves the patient. Hand hygiene is one of the very few repetitive steps of health care delivery and should become almost automatic. The environment of care should be designed to support this automation by having the hand hygiene resources in the appropriate place. Our study suggests that place should be mainly visible and easily accessible upon entry.

In general, there may be other routine components of inpatient care for which the environment should be designed to support healthcare providers. Human factors and work design methodologies can be used to identify these components and improve their associated work systems.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: The limitations of the current study are mostly related to the data. In principle, hand hygiene compliance is difficult to measure through observation due to the Hawthorne effect and patient privacy concerns. The current main priority for hand hygiene researchers is to find practical ways to reliably assess compliance. The study could perhaps be replicated using other sources of compliance data such as the consumption of cleaning agent.

Involving different healthcare organizations in the study could also help identify if the significant usability factors are organization specific or if they are generalizable to the whole healthcare industry.

Finally, the compliance data used had been originally collected for general quality improvement purposes but with no specific use in mind other than assessing hospital- and unit- wide compliance rates. Some rooms had very few observations and we had to exclude them from the study. So we suggest designing the study to make sure that all applicable locations and usability characteristics are included in the analysis with an appropriate sample size.

In general, collecting compliance data is costly and time consuming. Such data should support quality improvement not only by assessing key performance metrics, but also helping identify root causes. Our recommendation for researchers and quality managers is to collaborate with each other so that quality improvement data collection efforts can actually support the improvement of healthcare delivery through incorporating state-of-the art research finding.


Effect of hand sanitizer location on hand hygiene compliance

Cure, Laila et al.

American Journal of Infection Control

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Laila Cure, Ph.D., Assistant Professor, Dept. of Industrial and Manufacturing Engineering, & Wichita State University (2015). Placement of Hand Sanitizer Dispensers Important For Staff Compliance 

Last Updated on June 25, 2015 by Marie Benz MD FAAD