Study on the provision of disinfectant dispensers forms the basis for a new minimum standard

It is generally accepted that hand hygiene with alcohol-based hand disinfectants is the most effective measure for preventing healthcare-associated infections [1]. It is obvious that adequate hand hygiene for employees in health care facilities is only practicable if sufficient hand disinfectant dispensers are available at suitable locations. So far, however, only the German Robert Koch-Institute (RKI) has issued recommendations on the number of hand disinfectant dispensers and recommends at least one dispenser per bed in intensive care units or 0.5 per bed in normal wards. In contrast, neither the World Health Organisation (WHO) nor the American Centers for Disease Control and Prevention (CDC) nor the European Centre for Disease Prevention and Control (ECDC) have made such recommendations in their respective guidelines. In order to provide a basis for setting national and international minimum standards, a research group led by Professor Andreas Widmer of the SwissnosoNational Centre for Infection Prevention investigated the current number and locations of hand disinfectant dispensers in Swiss acute hospitals [1].

Survey-based results based on 20,000 acute care beds

The study was based on a survey using an anonymised and standardised questionnaire (adapted from the PROHIBIT study), sent to all 178 hospitals in the Swissnoso Surveillance Network between July and September 2019. Certified infection control and hospital epidemiology specialists collected data on the number of dispensers per bed, the location of the dispensers and hand disinfectant consumption using electronic and paper-based tools. A total of 110 hospitals (62%) participated, providing information on the supply of about 20,000 acute care beds in Switzerland.

Room entrance and washbasin proximity as preferred location for dispensers

In most hospitals, hand disinfectant dispensers were found at the entrance to the room (n = 92, 84 %) and near the washbasin (n = 81, 74 %). In just under half of the hospitals, dispensers were available near or at the bedside. While wall dispensers dominated in three quarters of the participating hospitals, only a quarter mainly offered gown bottles. However, the latter were mostly additionally available in 97 % of the hospitals.

Significantly more dispensers per bed than recommended by the Robert Koch-Institute

The survey of the total number of dispensers in the respective hospitals showed that Swiss hospitals are very well equipped, with an average of 2.4 hand disinfectant dispensers per patient bed. This number – based on intensive care and normal wards - is thus 2 to 4 times higher than the number recommended by the RKI for German hospitals. The study also showed that in large hospitals with more than 500 beds, the number of hand disinfectant dispensers correlated with hand disinfectant use. This could be an indication that the more dispensers available, the better hand hygiene is observed.