Publication on hand rub dispensers in German healthcare facilities

Amount of disinfectant dispensed varies greatly depending on the dispenser

Hand hygiene is the most effective measure to prevent healthcare-associated infections [1]. Fully functional, user-friendly hand rub dispensers are the cornerstone of hand hygiene. The amount of disinfectant dispensed by the dispensers has a crucial influence on effective hand disinfection [2]. However, these technical aspects of hand rub dispensers have hardly been considered in previous research. In many hospitals, they eke out an existence in a responsibility gap between wards, hygiene, cleaning and facility management. The performance of wall-mounted metal and plastic dispensers as well as point-of-care dispensers in 19 German healthcare facilities has now been investigated. The analysis revealed significant differences in the amount of disinfectant dispensed [2]. Deficits were also found with regard to the full functionality of the dispensers [2].

Focus on manual dispensers

The analysis evaluated 5,014 manually operated dispensers, of which more than three quarters (89.5 %) were wall-mounted and 10.5 % were point-of-care dispensers. The majority (56.2 %) of the 2,820 dispensers were metal dispensers with a specification of 0.75 to 1.5 mL. A total of 1,668 dispensers were plastic dispensers, 1,438 of which had a specification of 0.5 to 1.5 mL and 230 of which had a specification of 1.0 to 3.0 mL. Point-of-care dispensers with a specification of 0.7 to 3.0 mL were represented with a number of 526 units. During installation of an electronic monitoring system it was determined how much disinfectant the dispensers released when activated. For this purpose, each dispenser was manually operated five times, the average quantity was determined, and the results were compared with the manufacturer's specifications [2]. The condition of 946 wall-mounted dispensers in one hospital was examined in more detail [2].

Disinfectant – a question of the right amount

The quantity of disinfectant used is essential for the effectiveness of hand disinfection. 3 mL of disinfectant is recommended by the World Health Organization (WHO) for hygienic hand disinfection. This value is also specified in the European standard EN 1500 [2]. If the dosage is too low, the hands are not completely wetted, and antimicrobial efficacy is not given. Too large volumes may result in spillage and prolonged drying time [2]. The volume dispensed by dispensers therefore has an impact on the efficacy of hand disinfection.

Considerable differences depending on dispenser type

Most of the 5,014 dispensers tested dispensed more disinfectant than would be expected based on their specifications. The amount of disinfectant varied between 0.4 mL and 4.4 mL per pump actuation [2]. The largest amount was dispensed by plastic dispensers with a specification of 1.0 to 3.0 mL. Metal dispensers and plastic dispensers specified up to 1.5 mL dispensed comparable amounts of disinfectant most reliably [2]. A consistent amount of disinfectant is crucial for effective hand disinfection, as healthcare professionals are often trained to use a certain number of pump actuations [2]. If very different dispensers are used in a facility, it is difficult to learn the correct number of pump actuations to obtain the correct volume.

Of the 924 dispensers that were examined in detail, 29% had at least one problem that limited their functionality. In most cases, the disinfectant had been used up. The pump or dispenser was dirty or damaged, or there was a mechanical defect [2].

Download the full publication here.

The factsheet provides the most important results of the analysis.

Download the factsheet here

Factsheet showing illustrations of different dispensers and results of the study on hand rub dispensers in German healthcare facilities

ISO/CD2 23447:2022 – Establishing standards

Fully functional hand rub dispensers are the cornerstone of hand hygiene. In everyday clinical practice, however, many dispensers do not work properly and dispense very different amounts of disinfectant [2]. The ISO standard on Healthcare organization management - hand hygiene and Performance offers solutions to these problems. According to this standard, responsibilities for maintaining and refilling dispensers should be clearly defined. In addition, closed systems with pre-assembled disposable pumps should be used. Standardized dispensers make it easier for staff to use the appropriate amount of disinfectant. These measures could contribute to a significant improvement in infection prevention in healthcare facilities.

References:

1. World Health Organization (2009). WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care.

2. Herzer C et al. (2024). The state of handy rub dispensers in healthcare settings – a multicenter assessment in 19 German healthcare facilities. Antimicrobial & Infection Control 13: 118.