Alcohol-based Handrub Dispensers Research Articles

A simulation study of touch-free automatic alcohol-based handrub dispensers on hand hygiene disruption in healthcare settings

Automatic dispensers of alcohol-based handrub (ABHR) have been widely adopted in healthcare facilities to maintain hand hygiene (HH). A proper supply of energy and refill is crucial to ensure uninterrupted access to hand sanitizing and minimize workflow disruption and inefficiencies. Various energy design and refill replenishment technologies have emerged with promising potential to eliminate HH disruptions. However, there is a lack of quantitative studies assessing the design impact on hand hygiene performance in healthcare settings. In this paper, we employ data-driven discrete-event simulation (DES) to evaluate the long-term performance of various energy designs of automatic dispensers in healthcare facilities. We analyze 7 years of historical usage data from 4 US hospitals and identify the usage patterns, which serve as the input traffic for our simulation model. We then estimate the workflow disruption caused by different types of dispensers over a 6-year period, in terms of the number of missed HH opportunities, battery replacements, and duration of downtime. The simulation results suggest that the differences in performance are significant among dispenser types. In high usage, the number of missed HH opportunities caused by refill depletion ranges from 403.1 to 1232.4, and total downtime ranges from 0 to 96.3 h. Implementing proactive maintenance measures, such as service refill alerts, can greatly reduce the chances of ABHR depletion, resulting an 81.6 % decrease in HH disruptions for a single dispenser in high usage. Therefore, healthcare facilities should consider the variations in dispenser design, including the energy management system. They should also carefully study dispenser usage patterns to implement optimized policies and practices for ABHR refill maintenance to minimize overall missed HH opportunities.

1432. Touch-Free Automatic Alcohol-Based Hand Rub Dispensers in Healthcare Settings: A Simulation Study of Dispenser Energy Impact on Hand Hygiene Disruption

Abstract Background Hand hygiene (HH) matters because it decreases pathogen transmission that can cause infection. Automatic alcohol-based hand rub (ABHR) dispensers are widely adopted in healthcare facilities as the preferred means of HH. Traditional automatic dispensers have a large supply of batteries in the dispenser housing, whereas energy-on-the-refill (EOR) is a newer power supply solution, consisting of a relatively small battery attached to a refill bottle. The objective of this study was to assess dispenser design impact on missed HH opportunities and facility workflow disruption by mitigating battery maintenance. Methods We used date-driven discrete event simulation to evaluate the performance of three leading types of automatic dispensers in four common types of hospitals (Table 1). We analyzed up to 8 years of historical usage data and identified the usage pattern, which are used as the input traffic for our simulation model. Dispenser energy performance parameters were inputs to measure the workflow disruption of the different types of dispensers over a 6-year period in terms of battery replacements, duration of downtime, and the number of missed HH opportunities.Table 1:Summary of facility information and dispense event details to inform modeling. 1. This total included soap dispensers used for hand washing and ABHR dispensers that were not equipped with automated monitoring (e.g., those provided in office areas without patients). 2. These were the dispensers used in the analysis and modeling results. 3. Total dispenses for all ABHR dispensers during the entire time range. 4. This is the average number of ABHR dispenses daily for the facility for all dispensers. Results The simulation results suggested that dispensers with EOR technology were free of battery failures over the entire 6 years, and thus 0 HH misses were incurred due to dead batteries (Figure 1). All other designs had a significant amount HH misses due to battery failures, ranging from 2,514 (± 547) to 40,522 (± 4,506) per facility. However, the majority of HH misses were caused by empty ABHR refills. The maximum number of battery change events was 802 (± 0.60).Figure 1:Modeling results for each hospital and all dispenser types1 over the 6-year period simulation for the ABHR dispensers that comprise 80% of usage based on prior data. This figure displays (a) total dispenser downtime in hours, (b) the total number of HH misses due to battery failures, (c) the total number of HH misses due to ABHR availability (assuming 12 hours between an empty refill being replaced), and (d) the total number of battery change-out events. 95% CIs were also illustrated but might be unnoticeable, as they are on a much smaller scale compared to the mean. 1. Dispenser A is a traditional design with 4 “D” cell batteries in the housing and has an average dispense energy of 2.02 J/ml. Dispenser B is a traditional design with 3 “D” cell batteries in the housing and has an average dispense energy of 1.78 J/ml. Dispenser C is a new design with a “AA” battery on the refill and has an average dispense energy of 1.78 J/ml. Dispenser B is modeled at 1 dose and 2 doses because it has some ABHR formulations that can require 2 dispenses to meet the Healthcare Personnel Handwash test method antimicrobial efficacy success criteria. Conclusion Differences in dispenser design, including the energy management system and usage profiles have significant impact on HH performance, which in turn can affect infection risk. By adopting the EOR system, facilities can effectively eliminate the need for battery maintenance, resulting in labor and workflow efficiencies. The EOR system significantly reduces HH disruptions and may decrease complaints by caregivers, patients and visitors. Importantly facilities should carefully study dispenser usage patterns to implement optimized policies and practices for placement and refill maintenance of ABHR dispensers to minimize overall missed HH opportunities. Disclosures Nanshan Chen, n/a, GOJO Industries, Inc.: Grant/Research Support James W. Arbogast, PhD, GOJO Industries, Inc.: employee John J. McNulty, n/a, GOJO Industries, Inc.: employee Paul J. Brown, n/a, GOJO Industries, Inc.: employee Demetrius Henry, n/a, GOJO Industries, Inc.: employee Susan O'Hara, PhD, GOJO Industries, Inc.: Grant/Research Support Abedallah Al Kader, n/a, GOJO Industries, Inc.: Grant/Research Support Angela Hu, n/a, GOJO Industries, Inc.: Grant/Research Support Theodore T. Allen, PhD, GOJO Industries, Inc.: Grant/Research Support Cathy H. Xia, PhD, GOJO Industries, Inc.: Grant/Research Support

Tailored positioning and number of hand rub dispensers: the fundamentals for optimized hand hygiene compliance

Availability of alcohol-based hand rub (ABHR) dispensers at positions adapted to the work flow of healthcare workers (HCWs) is decisive in order to carry out indication-based hand rubbing. Although requirements and guidelines regarding the positioning of ABHR dispensers are in place, scientific evidence is often lacking. In order to analyse the impact of the location and number of ABHR dispensers on hand hygiene performance, additional dispensers were systematically placed in patient rooms in a surgical 38-bed ward at Marburg University Hospital, Germany to complement the existing dispenser locations. ABHR use was monitored continuously before and after complementation using the NosoEx hand hygiene monitoring system. The ward had 53 dispensers before the intervention and 82 dispensers after the intervention. The addition of dispensers increased ABHR consumption across the entire ward. Before the intervention, mean consumption was 20.6 mL/patient-day, whereas mean consumption after the intervention was 25.3 mL/patient-day. Depending on the combination of dispenser locations, consumption increased through targeted supplementation in patient rooms. The presence of two or three dispensers per patient room resulted in significantly greater ABHR consumption compared with one dispenser per patient room. The preferred location combinations were entrance-front bed-back bed and entrance-foot end. ABHR consumption can be increased significantly by optimizing the position and number of dispensers. The outstanding factors are visibility and integrability of dispenser use into the work flow; in particular, a dispenser should be positioned in the entrance area. Recommendations should be optimized with regard to the required number and location of dispensers in patient rooms.

Improving Access to Alcohol-Based Hand Rub Dispensers for Surgical Hand Antisepsis.

Improving Access to Alcohol-Based Hand Rub Dispensers for Surgical Hand Antisepsis.

The Utility of Interaction Design as a Novel Tool to Improve Hand Hygiene Frequency on a Pediatric Hematology-Oncology Ward

Johanna Blaak, W21C, University of Calgary; Rachel DiMaio, University of Calgary; Julia Kupis, University of Calgary; Ross Sweetzir, Cisco Systems; Conny Betuzzi, Alberta Children’s Hospital, Alberta Health Services; Corey Dowler, Alberta Children’s Hospital, Alberta Health Services; Krista McIntytre, Alberta Children’s Hospital, Alberta Health Services; Jaime Kaufman, University of Calgary; Greg Hallihan, University of Calgary; John Conly, Foothills Medical Centre; Joseph Vayalumkal, Alberta Childrens HospitalBackground: Interaction design offers a novel interventional strategy to enhance hand-hygiene compliance (HHC) and reduce hospital-acquired infections (HAIs) in the pediatric setting. A quality improvement initiative in collaboration with the University of Calgary and Alberta Health Services led to the implementation of a pilot project with sensor-embedded alcohol -based hand rub (ABHR) dispensers at a hematology-oncology and hematopoietic stem cell transplant unit at Alberta Children’s Hospital (ACH). Methods: Internet of things (IoT) sensors were installed in ABHR dispensers (n = 3) on the unit. Usage data were transmitted to a local server using an MQTT messaging protocol for 16 weeks. Real-time data visualization was presented on a central display next to the nursing station with 11 unique pediatric themes including dinosaurs, transportation, and Canadian animals. Data were collected with and without visualization, and frequency of use (FoU) was determined for both periods. Qualitative interviews with unit stakeholders (n = 13) were held to determine perceptions of the intervention. Results: During the first 8 weeks of the study period, the mean daily use without visualization was 47 times (SD, 14.5) versus 99 times (SD, 23.9) with visualization. When accounting for novelty, by removing the first week of data, the mean daily use was 92 (SD 19.6). The percentage increase from period 1 to period 2 was 96.6%, accounting for novelty. Qualitative interviews with stakeholders (n = 13) on the unit indicated that the intervention increased their personal awareness of hand hygiene (75%) and acted as a constant reminder to perform hand hygiene for everyone on the unit including nonclinical staff, patients, and family members (92%). Conclusions: These limited data suggest that interaction design may improve HH frequency and show promise as a tool for increased HH awareness and education. Interaction design provides a unique, innovative, and acceptable hand hygiene improvement strategy for staff, patients, and families in the pediatric inpatient setting.Funding: NoneDisclosures: None

Critical Reliability Issues of Common Type Alcohol-Based Handrub Dispensers

BackgroundHand hygiene can only be efficient if the whole hand surface is treated with sufficient alcohol-based handrub (ABHR); therefore, the volume of handrub applied is a critical factor in patient safety. The proper amount of ABHR should be provided by handrub dispensers. The aim of this study was to investigate the dispensing performance of wall-mounted ABHR dispensers commonly employed in hospital settings.MethodIn a multicenter study, we tested 46 dispensers (22 in laboratory and 24 in clinical environments), measuring dispensed ABHR volume during continuous use and after a period of non-use. The influence of the pumping mechanism, liquid level, ABHR formats, handrub composition, temperature, and atmospheric pressure was investigated.ResultsA total of 7 out of the 22 investigated dispensers (32%) lost a significant amount of handrub; greater than 30% of the nominal volume after 8 h of non-use, thus frequently dispensing suboptimal volume, as measured in laboratory settings. Key influencing factors were found to be handrub format (gel or liquid), handrub level in the container and type of dispenser. When gel ABHR was used, after 4 h of non-use of the dispensers, the volume of the dispensed amount of ABHR insignificantly changed (97% of the original amount), while it technically decreased to zero in the case of liquid ABHR (1% of the original amount). The liquid level had a medium effect on the dispensed volume in each investigated case; the magnitude of this effect varied widely depending on the dispensing mechanism. When dispensers were in continuous use, they dispensed a cumulated 3 mL of ABHR from two consecutive pushes, while when they were not in use for 1 h, up to 4 consecutive pushes were necessary to provide a total of 3 mL ABHR. Design and production quality were also identified as important contributing factors with respect to the volume dispensed. Data collected in clinical settings confirmed these findings, for multiple types of dispensers.ConclusionAll ABHR dispensers should be regularly audited to control the reference volume distributed, with particular attention paid to regular mechanical pump units filled with liquid handrub.

The effect of eye images and a social norms message on healthcare provider hand hygiene adherence.

Depictions of eye images and messages encouraging compliance with social norms have successfully motivated behavioral change in a variety of experimental and applied settings. We studied the effect of these 2 visual cues on hand hygiene adherence in a cohort of hospital-based healthcare providers participating in an electronic monitoring and feedback program. Prospective, quasi-experimental study utilizing an interrupted time-series design. Intervention placards depicting an image of eyes, a social norms message, or a control placard were placed near soap and alcohol-based hand-rub dispensers on 2 hospital units. Placards were alternated every 10 days. Hand hygiene opportunities and adherence rates were assessed electronically via the CenTrak Hand Hygiene Compliance Solution. A total of 166 nurses and certified nursing assistants (74 on a medical-surgical unit and 92 on a progressive care unit) were monitored electronically over the 4-month study period. In total, 184,172 electronic observations were collected (110,903 on a medical-surgical unit and 73,269 on a progressive care unit). The median daily number of electronic observations was 1,471 (interquartile range, 1,337-1,584). The preintervention baseline hand hygiene adherence rate was 70%. No statistically significant increase in hand hygiene adherence was observed as a result of either intervention. Displaying eye images or a social norms message in the hospital environment did not result in measurable improvements in HH adherence in a cohort of healthcare providers participating in an electronic monitoring and feedback program.

Do wearable alcohol-based handrub dispensers increase hand hygiene compliance? - a mixed-methods study

BackgroundHand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance.MethodsIn this study, we introduced wearable dispensers for ABHR in an Emergency Department (ED) well equipped with mounted ABHR dispensers and accompanied this single-modal intervention by a quasi-experimental mixed-method study. The study was performed in the ED of the University Hospital Zurich, Switzerland, a 950-bed tertiary teaching hospital. During a five-week baseline period and a seven-week intervention period, we observed HH compliance according to the WHO ‘Five Moments’ concept, measured ABHR consumption, and investigated perceived ABHR availability, self-reported HH compliance and knowledge of HH indications by questionnaire. Multivariable logistic regression was used to identify independent determinants for HH compliance. In addition, semi-structured interviews were conducted and thematically analyzed to assess barriers and facilitators for the use of the newly introduced dispensers.ResultsAcross 811 observed HH opportunities, the HH compliance for all moments was 56% (95% confidence interval (CI), 51–62%) during baseline and 64% (CI, 59–68%) during intervention period, respectively. In the multivariable analysis adjusted for sex, profession, and WHO HH moment, there was no difference in HH compliance between baseline and intervention (adjusted Odds ratio: 1.22 (0.89–1.66), p = 0.22), No significant changes were observed in consumption and perceived availability of ABHR. During intervention, 7.5% ABHR was consumed using wearable dispensers. HCP perceived wearable dispensers as unnecessary since mounted dispensers were readily accessible. Poor ergonomic design of the wearable dispenser emerged as a main barrier, especially its lid and fastening mechanism. Interviewees identified two ideal situations for wearable dispensers, HCP who accompany patients from ED to other wards, and HCP approaching a patient from a non-patient areas in the ED such as the central working station or the meeting room.ConclusionThe introduction of wearable dispensers did not increase observed hand hygiene compliance or ABHR consumption in an ED already well equipped with mounted dispensers. For broader acceptance and use, wearable dispensers might benefit from an optimized ergonomic design.

A quasi-experimental study to determine the effects of a multifaceted educational intervention on hand hygiene compliance in a radiography unit.

BackgroundWhilst numerous studies have investigated nurses’ compliance with hand hygiene and use of alcohol-based hand rub (ABHR), limited attention has been paid to these issues in allied health staff. Reports have linked infections to breaches in infection control in the radiography unit (RU). With advances in medical imaging, a higher proportion of patients come into contact with RU staff increasing the need for good hand hygiene compliance. This study aimed to evaluate effectiveness on compliance of an intervention to improve awareness of hand hygiene in the RU of a district hospital.MethodsA quasi-experimental study design including questionnaires assessing knowledge and attitudes of hand hygiene and direct observation of participants was used to evaluate an educational programme on hand hygiene of the RU of a large district hospital. All healthcare workers (HCW), comprising 76 radiographers, 17 nurses, and nine healthcare assistants (HCA), agreed to participate in the study. Of these, 85 completed the initial and 76 the post-test anonymous questionnaire. The hand hygiene compliance of all 102 HCW was observed over a 3-week period prior to and after the intervention. The 2-month intervention consisted of talks on hand hygiene and benefits of ABHR, provision of visual aids, wall-mounted ABHR dispensers, and personal bottles of ABHR.ResultsBefore the intervention, overall hand hygiene compliance was low (28.9 %). Post-intervention, compliance with hand hygiene increased to 51.4 %. This improvement was significant for radiographers and HCA. Additionally, knowledge and attitudes improved in particular, understanding that ABHR can largely replace handwashing and there is a need to perform hand hygiene after environmental contact. The increased use of ABHR allowed HCW to feel they had enough time to perform hand hygiene.ConclusionsThe educational intervention led to increased awareness of hand hygiene opportunities and better acceptance of ABHR use. The reduced time needed to perform hand rubbing and improved access to dispensers resulted in fewer missed opportunities. Although radiographers and other allied HCW make frequent contact with patients, these may be mistakenly construed as irrelevant with respect to healthcare associated infections. Stronger emphasis on hand hygiene compliance of these staff may help reduce infection risk.

WITHDRAWN: Surgical patients’ safety in Polish hospital environment in the context of selected infection control practices

Background Surgical site infections (SSI) still continue to be a major cause of morbidity and mortality, despite the improvement in methods for infection control as well as surgical practices. The aim of this work is the presentation and analysis of SSI control practices in selected surgical wards in Poland as compared to other European countries. Methods The presented data were obtained using a standardized questionnaire within a European project devoted to describing and analyzing the surveillance of nosocomial infections in individual European countries. Results In all studied wards, written procedures of SSI prevention were present, as well as obligatory training of ward personnel concerning infection control. Alcohol based handrub dispensers were available in over 75% points of care in most wards, as opposed to belt/pocket bottles, which were available for a small number of ward personnel. Alcohol solutions were most often used for skin preparation. Shaving immediately before operations was the most common way of hair removal. A WHO checklist was used in 20% of the studied wards. Conclusions Based on the results of the study, the organization of surveillance infections in Polish surgical wards appears to be satisfactory. However, practical implementation of surgical site infection prophylaxis calls for significant alterations, both in terms of executing training as well as implementing practices in the wards or the operating room. On the one hand, due to a lack of multicenter studies on the epidemiology of SSI in Polish surgical wards, actual exposure to SSI cannot be assessed.

The Promise of the Internet of Things in Healthcare: How Hard Is It to Keep?

Internet of Things is starting to be implemented in healthcare. An example is the automated monitoring systems that are currently being used to provide healthcare workers with feedback regarding their hand hygiene compliance. These solutions seem effective in promoting healthcare workers self-awareness and action regarding their hand hygiene performance, which is still far from desired. Underlying these systems, an indoor positioning component (following Internet of Things paradigm) is used to collect data from the ward regarding healthcare workers' position, which will be later used to make some assumptions about the usage of alcohol-based handrub dispensers and sinks. We found that building such a system under the scope of the healthcare field is not a trivial task and it must be subject to several considerations, which are presented, analyzed and discussed in this paper. The limitations of present Internet of Things technologies are not yet ready to address the demanding field of healthcare.

Impact of implementation of the World Health Organization multimodal hand hygiene improvement strategy in a teaching hospital in Taiwan

Hand hygiene (HH) is considered to be the most simple, rapid, and economic way to prevent health care-associated infection (HAI). However, poor HH compliance has been repeatedly reported. Our objective was to evaluate the impact of implementing the updated World Health Organization (WHO) multimodal HH guidelines on HH compliance and HAI in a tertiary hospital in Taiwan. We conducted a before-and-after interventional study during 2010-2011. A multimodal HH promotion campaign was initiated. Key strategies included providing alcohol-based handrub dispensers at points of care, designing educational programs tailored to the needs of different health care workers, placement of general and individual reminders in the workplace, and establishment of evaluation and feedback for HH compliance and infection rates. Overall HH compliance increased from 62.3% to 73.3% after 1year of intervention (P<.001). The rate of overall HAI decreased from 3.7% to 3.1% (P<.05), urinary tract infection rate decreased from 1.5% to 1.2% (P<.05), and respiratory tract infection rate decreased from 0.53% to 0.35% (P<.05). This campaign saved an estimated $940,000 and 3,564 admission patient days per year. The WHO multimodal HH guidelines are feasible and effective for the promotion of HH compliance and are associated with the reduction of HAIs.

Environmental sampling for Clostridium difficile on alcohol-based hand rub dispensers in an academic medical center.

Clostridum difficile is a gram-positive, spore-forming anaerobic bacillus that has substantial associated morbidity, mortality, and associated healthcare burdens. Clostridium difficile spores are not destroyed by alcohol. Alcohol gel dispensers are used commonly as the hand sanitization method of choice in hospitals. It is possible that gel dispensers are fomites for C. difficile. Thirty alcohol-based gel dispenser handles outside of rooms of patients with active C. difficile infection were sampled. The samples were assessed for C. difficile by both culture and polymerase chain reaction (PCR). The samples were also assessed for other organisms by culture. No C. difficile was cultured or detected by PCR on any of the gel dispensers. Coagulase-negative Staphyloccus spp., diptheroids, and Bacillus spp. were the organisms detected most commonly. At our institution, C. difficile is not present on alcohol-based gel dispensers, but other potentially pathogenis are.

Effect of Varying the Number and Location of Alcohol-Based Hand Rub Dispensers on Usage in a General Inpatient Medical Unit

We sequentially increased the number of wall-mounted alcohol-based hand rub dispensers in a small medical unit to evaluate effects on hand hygiene performance. Above a certain point, addition of more dispensers did not increase hand hygiene frequency, which appeared to be influenced more by location than by total number of dispensers.

Effectiveness of a hand hygiene promotion strategy using alcohol-based handrub in 6 intensive care units in Colombia

Hand hygiene is an effective strategy for the prevention of health care-associated infection (HAI). We investigated the effect of a hand hygiene promotion strategy introducing alcohol-based handrub (AHBR) on the incidence of HAI in a university hospital in Colombia. A Prospective cohort study was performed in 6 intensive care units from January 2001 to December 2005. HAI were identified using standard US Centers for Disease Control and Prevention definitions. Alcohol-based handrub dispensers were installed between February and June 2002. Total ABHR consumption was 5,794 L (mean, 28.9 L per 1,000 patient-days) and significantly increased over time (+9.2% per year; P < .001). Of 14,516 patients cumulating 166,498 patient-days, 2,398 (16.5%) acquired a total of 3,490 HAI episodes (20.9per 1,000 patient-days). Incidence densities for central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia, and urinary tract infections were 7.7, 10.6, and 3.6 episodes per 1,000 device-days, respectively. A significant decrease was observed for CLABSI (-12.7% per year; P < .001) with low nurse-to-patient ratio independently associated with infection (odds ratio, 1.11; 95% confidence interval: 1.07-1.16; P < .001). Improved hand hygiene measured by increased ABHR consumption resulted in CLABSI reduction. Low nurse-to-patient ratio is independently associated with HAI in an upper-middle income country.