Hand Hygiene Behavior in a Pediatric Emergency Department and a Pediatric Intensive Care Unit: Comparison of Use of 2 Dispenser Systems

Abstract

• Background Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene practices warrant testing. • Objective To compare the frequency of use of manually operated and touch-free dispensers of sanitizer for hand hygiene. • Methods Manual and touch-free dispensers of alcohol sanitizer were placed in the emergency department and an intensive care unit of a large pediatric hospital for two 2-month periods for each type of dispenser. Counting devices installed in each dispenser and direct observations were used to determine actual frequency of and indications for hand hygiene. • Results The touch-free dispensers were used significantly more often than were the manual dispensers. The means for the number of episodes of hand hygiene per hour were 4.42 for the touch-free dispensers and 3.33 for the manual dispensers (P = .04); the means for the number of episodes per patient per hour were 2.22 and 1.79, respectively (P = .004); and the means for the number of uses of the dispenser per day were 41.2 and 25.6, respectively (P = .02). However, the overall compliance rate was 38.4% (2136 episodes of hand hygiene per 5568 indications for hand hygiene). • Conclusions The type of dispensing system influenced hand hygiene behavior. Nevertheless, overall hand hygiene compliance remained low. In order for interventions to have a major effect on hand hygiene, multiple factors must be considered.

Infection Prevention in the Emergency Department

“…At the level of the individual provider, interventions have ranged from posting high visibility signs promoting hand hygiene and circulating educational materials to staff to trialing touch-free as well as personal wearable hand sanitizer dispensers. 14,20,21 Workflow optimization and standardization have also been examined as a means of streamlining bedside procedures and reducing extraneous hand hygiene events in the course of patient care. 22 Larger, multifaceted interventions incorporating group and one-on-one education, a shared culture of patient safety, designated clinician champions to promote and model proper hand hygiene, improved access to alcohol-based hand rub, and routine hand hygiene monitoring through direct observation have led to sustained improvements in ED hand hygiene adherence.…”

Infection control in clinical placements: experiences of nursing and midwifery students

“…Compliance with ICPs such as hand hygiene and the use of protective clothing has been found to be less than optimal for several decades (Larson 1981, 1995, Larson et al. 2005).…”

Impact of Wearable Alcohol Gel Dispensers on Hand Hygiene in an Emergency Department

“…There are only a few studies of HH and other infection control practices among emergency department (ED) staff 5–8 and these have often reported poor compliance. The administration and staff of the study ED perceived a problem with accessibility of HH facilities and therefore requested a wearable dispensing device to improve HH compliance.…”