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. 2018 Nov 23:7:143.
doi: 10.1186/s13756-018-0439-5. eCollection 2018.

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

Jonas Keller #  1 , Aline Wolfensberger #  1 , Lauren Clack  1 , Stefan P Kuster  1 , Mesida Dunic  1 , Doris Eis  2 , Yvonne Flammer  1   3 , Dagmar I Keller  2 , Hugo Sax  1
Affiliations

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

Jonas Keller et al. Antimicrob Resist Infect Control. .

Abstract

Background: Hand 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.

Methods: In 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.

Results: Across 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.

Conclusion: The 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.

Keywords: Availability; Clip on dispensers; Compliance; Emergency room; Hand hygiene; Pocket dispensers; Point of care; Wearable dispensers.

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Conflict of interest statement

Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Hand hygiene compliance and consumption of alcohol based hand rub. Legend: The bar graph depicts consumption of ABHR in milliliters by mounted dispensers (blue bars) and wearable dispensers (orange bars). The line graph depicts HH compliance in percent. The five-week baseline period (weeks 15 to 19) and the seven-week intervention period (weeks 22 to 28) are separated by a two-week (weeks 20 and 21) period dedicated to preparing the intervention. Abbreviations: ABHR = Alcohol-based hand rub; HH = hand hygiene; ml = milliliters
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