A systematic approach for the location of hand sanitizer dispensers in hospitals

Abstract

Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.

Effect of hand sanitizer location on hand hygiene compliance

“…We used the metrics proposed by Cure et al 29 to evaluate the locations of sanitizer dispensers. The authors proposed 2 metrics: a usability score to evaluate individual locations within a room and a standardization score to complement the usability score at the unit level.…”

“…It is suggested to make P k˛K u k ¼ 1 for ease of interpretation. Further suggestions to determine the weights of each characteristic are provided in Cure et al 29 Because hand hygiene data are usually collected by hospital patient care units, the individual room usability scores were used to calculate an average usability of a patient care unit as follows:…”

“…The standardization score is a unit characteristic and represents the maximum proportion of rooms within the unit with a dispenser installed in a consistent location, regardless of the actual usability of such location. 29 For example, if a unit has a standardization score of 1, it means that 100% of the rooms in the unit have a sanitizer dispenser in the same location (eg, 100% of the rooms have a sanitizer by the entrance). Likewise, a standardization score of 0.6 means that 60% of the rooms in the unit have a sanitizer placed in the same location, whereas the sanitizers in the remaining 40% of the rooms are in different locations.…”

“…Most of these studies recommend placing the dispensers by the entrance of rooms and by the point of care to support the World Health Organization's My 5 Moments for Hand Hygiene. 29 Nevertheless, few studies have focused on studying the effect of the physical location of hand sanitizer dispensers on compliance 14,15,30,31 or on providing explicit guidelines to evaluate and determine such locations. 29,32,33 This study uses an engineering approach to quantitate the relationship between usability characteristics of hand sanitizer locations within hospital rooms and hand hygiene compliance rates obtained from existing hospital data.…”

Hand hygiene behavior in a tertiary university hospital: differences between surgical and nonsurgical departments

“…The main components of the campaign comprised training, distribution of posters and provision of materials encouraging patients and relatives to clean their hands [15]. Furthermore, the campaign focused on improving environmental barriers, as recent studies have confirmed that HH compliance can be affected by the accessibility of sanitizing products [16,17].…”