Anyone who sets foot in a health facility hopes to leave healthier than, or as healthy as, when one came in. The problem is that health facilities are under constant threat of healthcare-associated infections (HCAIs), described by the World Health Organization (WHO) as one of the most frequent harmful situations during care delivery .

Incidents can result in longer hospital visits, long-term disabilities, significant financial burdens on healthcare institutions and, most severely, an increase in deaths. According to the Public Health Agency of Canada (PHAC), more than 200,000 patients are infected every year while receiving treatment, with 8,000 of these cases resulting in death . To combat this concern, the PHAC issues infection control guidelines for all provinces, territories and healthcare organizations.

Hand hygiene remains the single most effective way to prevent the spread of communicable diseases and infections. Recommendations from the WHO and PHAC essentially shed light on individual behaviours to help curb HCAIs in health facilities; however, it is equally important to consider the environment in which health professionals, patients and visitors are asked to practice safe hand hygiene.

Actually, studies indicate that hand hygiene behaviour alone is not the only key factor for achieving higher compliance rates; it turns out that the placement of soap/sanitizer dispensers plays an important role as well .

Hand hygiene recommendations

There are a multitude of recommendations on lowering the number of HCAIs worldwide. The WHO highlights the importance of good hand hygiene in preventing HCAIs. It suggests the most important aspect is “cleaning your hands at the right time and in the right way.”

In addition to the WHO’s hand hygiene improvement strategy and guidelines on healthcare hand hygiene, it identifies five moments for hand hygiene in healthcare. Analyzing the natural workflow of the healthcare system, they highlight the following moments to be mindful of: before patient contact, before aseptic task, after body fluid exposure risk, after patient contact and after contact with patient surroundings .

Similarly, according to the PHAC, “adherence to hand hygiene recommendations is the single most important practice for preventing the transmission of microorganisms in healthcare and directly contributes to patient safety.” In 2014, it released Best Practices for Hand Hygiene, which outlines specific steps in reducing the chance of infection in patients. Some of PHAC’s key recommendations include: knowing why and when to perform hand hygiene, understanding barriers and enablers that might influence hand hygiene, choosing hand hygiene agents and applying the correct hand hygiene techniques.

While identifying and correcting behaviour is essential in reducing the number of HCAIs, it is important to remember the impact environment has on behaviour. The layout and landscape of a healthcare facility can directly affect the accessibility of dispenser stations and, therefore, the regular practice of proper hand hygiene within the facility.

Strategic dispenser placement

Making sure dispensers are correctly placed is essential to improving hand hygiene practices. In fact, optimizing dispenser placement can result in a 50-per-cent increase in use. Furthermore, enhancing the visibility of dispensers does more to increase usage than simply increasing the number of dispensers within a healthcare facility.

General principles have been developed based on both SCA-sponsored research and independent findings from academic research. Keeping the WHO five moments in mind, these principles are built around four areas commonly found in hospitals and recommend strategic dispenser placement as follows:

• Hospital entrance: Few visitors perform hand hygiene when entering the hospital, which is why clear placement is integral to the education of visitors. Clear and simple information regarding hand hygiene should also be provided near dispensers.
• Semi-private patient room: These rooms require multiple dispensers to ensure use. Dispensers placed near the entrance and sink are used more frequently, as consistent and familiar locations increase likelihood of use.
• Private patient room: Dispensers should be placed on ‘walking routes’ and immediately visible when entering the room. They should be clearly visible and located near areas care is performed.
• Nurse station: Patient visits usually begin and end at the nurse station, so dispensers should be placed visibly nearby. In an SCA-sponsored study, dispensers placed by the nurse station were used more frequently than dispensers placed behind patient beds.

The focal point of the study is ensuring the visibility and ease of access to dispensers. Doctors and nurses are often busy and should not have to go out of their way to practice hand hygiene protocol.

Moving forward

HCAIs present an important obstacle in healthcare which must be addressed. Research indicates ways it’s possible to effectively combat the presence of HCAIs in healthcare facilities through a combination of behaviour and environment.

While there are certain behaviours recommended by the WHO and PHAC that may be adjusted to limit the occurrence of HCAIs, the facility’s environment plays a large role in preventing infection. Ensuring soap/sanitizer dispensers are visible, easily accessible to visitors and staff and mirror the workflow of nurses and doctors is an important step towards lowering the risk and number of HCAIs worldwide.

Tom Bergin is health care marketing director for SCA’s Away from Home Professional Hygiene business in North America.