Optimal Location for Alcohol-Based Hand Rub in an ICU
Although hand hygiene reduces the risk of transmission of infectious agents, compliance by healthcare workers (HCW) with the recommended instructions for hand hygiene is low. The introduction of alcohol-based hand rub (ABHR) dispensers is reported to have a positive influence on hand hygiene compliance, which is attributed to (amongst other factors) the potential for increased access and the visibility of this device.
Greater accessibility has been achieved by placing ABHR dispensers in the vicinity to a bed: e.g. mounted on all patients' beds or placed at each bedside, or by distributing individual bottles of ABHR to HCW. Thomas et al. reported that the location of the ABHR dispenser is of more importance than the quantity of ABHR dispensers on a surgical intensive care unit (ICU). In their study, the ABHR dispensers were secured at the end of a trapeze-bar apparatus which was connected to the patient's bed. In this way the dispenser remains at eye level for attendants standing at bedside. This location resulted in a higher volume of use for ABHR compared to placing dispensers at the customary locations (e.g. on walls inside/outside the patient rooms, and adjacent to the lavatories) or placing the dispensers at customary locations in greater quantity. Birnbach et al. used a simulation in a real-size replica to evaluate the location of an ABHR dispenser; they found that when the dispenser was in clear view of the physicians this resulted in better compliance. Nevo et al. reported that compliance was improved when the front of the dispenser and an accompanying poster were in the line of sight on entering the room.
The optimal location of an ABHR dispenser is associated with its potential for increased access (e.g. close to the point of care, unobstructed access) and visibility. However, due to the variety in the layout of patient rooms in different hospitals, there is no standardized location for ABHR dispensers, and no method is available for establishing the best location for these dispensers.
Therefore, we composed a method to determine the optimal location for an ABHR dispenser in a patient room. This method consists of three types of assessment: workflow observations, interviews with nurses and physicians, and electronic measurements of ABHR dispenser usage. Workflow observations and interviews with HCW were used to identify possible preferred locations for an ABHR dispenser in the test room. These locations were then evaluated with electronic measurements of the frequency of use of the ABHR dispensers and by interviewing HCW.
This paper describes the results of the application of this method on an ICU in a single patient room.
Background
Although hand hygiene reduces the risk of transmission of infectious agents, compliance by healthcare workers (HCW) with the recommended instructions for hand hygiene is low. The introduction of alcohol-based hand rub (ABHR) dispensers is reported to have a positive influence on hand hygiene compliance, which is attributed to (amongst other factors) the potential for increased access and the visibility of this device.
Greater accessibility has been achieved by placing ABHR dispensers in the vicinity to a bed: e.g. mounted on all patients' beds or placed at each bedside, or by distributing individual bottles of ABHR to HCW. Thomas et al. reported that the location of the ABHR dispenser is of more importance than the quantity of ABHR dispensers on a surgical intensive care unit (ICU). In their study, the ABHR dispensers were secured at the end of a trapeze-bar apparatus which was connected to the patient's bed. In this way the dispenser remains at eye level for attendants standing at bedside. This location resulted in a higher volume of use for ABHR compared to placing dispensers at the customary locations (e.g. on walls inside/outside the patient rooms, and adjacent to the lavatories) or placing the dispensers at customary locations in greater quantity. Birnbach et al. used a simulation in a real-size replica to evaluate the location of an ABHR dispenser; they found that when the dispenser was in clear view of the physicians this resulted in better compliance. Nevo et al. reported that compliance was improved when the front of the dispenser and an accompanying poster were in the line of sight on entering the room.
The optimal location of an ABHR dispenser is associated with its potential for increased access (e.g. close to the point of care, unobstructed access) and visibility. However, due to the variety in the layout of patient rooms in different hospitals, there is no standardized location for ABHR dispensers, and no method is available for establishing the best location for these dispensers.
Therefore, we composed a method to determine the optimal location for an ABHR dispenser in a patient room. This method consists of three types of assessment: workflow observations, interviews with nurses and physicians, and electronic measurements of ABHR dispenser usage. Workflow observations and interviews with HCW were used to identify possible preferred locations for an ABHR dispenser in the test room. These locations were then evaluated with electronic measurements of the frequency of use of the ABHR dispensers and by interviewing HCW.
This paper describes the results of the application of this method on an ICU in a single patient room.
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