This is the third of a five-part series that covers best practices for driving effective hand hygiene compliance. The series discusses the impact that both product and behavior drivers have on hand hygiene compliance. This blog addresses the impact of product availability, accessibility and ease-of-use.
In the fight against healthcare associated infections (HAIs), and in particular when we discuss hand hygiene compliance, it is critical to be aware of the facts around product availability, location, and ease-of-use. Like with any other behavior, an easy action helps to increase compliance.
Product availability is essential, and is one of those things that cannot be taken for granted. The World Health Organization (WHO) in its 2009 Guidelines on Hand Hygiene in Health Care cited several studies that found one of the self-reported factors for poor adherence to hand hygiene among healthcare workers is a lack of soap, paper towels and hand cleaning agents. Empty dispensers equal lower compliance and increased risk for patient and staff safety through spread of infectious germs. Another self-reported factor for lack of hand hygiene compliance among staff is “not thinking about it/forgetfulness.”
- Transparent dispenser covers can help staff visually monitor content levels without opening dispensers or relying on small view windows
- Dispensers, especially if they are color-coded or contain messaging around hand hygiene, can serve as a visual reminder for staff to clean their hands
Access to hand hygiene dispensers within staff workflow is also a must. WHO 2009 hand hygiene guidelines found the “perception that hand hygiene is easy to perform/easy access to alcohol-based handrub”1 is one of the key factors that influences good adherence to hand hygiene. Healthcare organizations should take a strategic approach to positioning hand hygiene dispensers and products, making sure that placement matches clinical workflow patterns. In addition, the CDC and WHO recognize that it is essential for hand sanitizer to be immediately accessible without healthcare workers having to leave the patient zone, enabling staff to clean their hands quickly and easily at the critical point of patient care.
- Hospitals should provideaccessible point-of-care dispensers that will enable healthcare facilities to more readily comply with hand hygiene best practices. The patient’s bedside location is appropriate when following WHO 5 Moments or CDC guidelines
- Dispensers can be mounted at the patient’s bedside providing easy and consistent access
Fail-safe your hand hygiene system to assure nothing hinders optimal use. Color-coded dispensers help staff know exactly which product they are accessing. Adding directions to dispensers on how to properly wash or sanitize hands helps ensure compliance with best practices. Ensure soap and sanitizer products are especially formulated for use in the demanding healthcare environment where healthcare professionals may be required to clean their hands up to 100 times per shift. Skin health is a vital component of hand hygiene compliance.
Other possible obstacles to address include sticky residue, dryness and chapping, skin sensitivity, and even unpredictable dispensing from a clogged dispenser – all of which can hinder the regular use needed for optimal compliance. Not all hand hygiene products are created equal, so be sure you, and more likely a team, conduct a comprehensive evaluation including these ease-of-use issues, along with clinical efficacy and cost. Hand sanitizer and soap solutions are not commodity products. Performance on these attributes critical to users are a crucial aspect of proper product selection.
You can pinpoint the right product by asking these questions:
- Satisfaction: Staff satisfaction is vital. Will staff want to use it? An independent study showed that the foam format soap was preferred by 4 out of 5 users.3
- Skin Health: Does your skin feel moisturized and healthy after use? Choose a product that contains emollients which improve skin quality and eliminate common hand hygiene barriers such as dry or cracked skin.
- Coverage: Does the product spread easily over the entire surface of the hands, and provide enough sanitizer to meet the recommended 20-30 seconds wet contact time2?
- Compatibility: Is the product compatible with latex and nitrile gloves, and can you easily apply gloves after product usage?
- Spills: Does the product remain on the hands during application or does it create a mess? Gel products tend to liquefy on contact with hands, creating spills and splashes.
- Clogging: Does the product tend to clog at the tips of dispensers or pumps? Does clogging result in unpredictable dispensing or shooting of the product on walls and floors? Foam products tend to create less clogging than gels.
- Build-up: Does the product accumulate on the skin after multiple applications? Does the skin feel sticky after product use? Unlike gel sanitizers, foam sanitizers do not contain gelling agents avoiding a sticky hand feel after use.4
Dispenser design can also help eliminate common barriers to compliance by using vibrant color-coding to provide visual cues and ensure the proper product is loaded in each dispenser. Language-neutral icons can provide easy-to-understand usage instructions based on established hand hygiene best practices, and multilingual product identification clearly communicates the dispenser contents.
Our next blog in this five-part series will move from product drivers to behavioral drivers of hand hygiene compliance, addressing the importance of hand hygiene – why, when and how.
1 The World Health Organization, Guidelines on Hand Hygiene in Health Care, 2009
2 The World Health Organization, How to Handrub, 2009
3 Deb independent research study, 2016.
4 DebMed Skin Care Product Guide, 2016