A lack of standardization in how hand hygiene-related solutions are arranged at hospital emergency department washbasins may have an effect on performance, according to a study published in the American Journal of Infection Control.
To examine the extent to which incorrect hand hygiene occurred as a result of the inability to easily distinguish between different hand hygiene solutions placed at washbasins, researchers conducted a direct observational study using six ceiling-mounted, motion-activated video camera surveillance at the washbasins of a hospital in Australia.
All total, 459 episodes of hand hygiene were recorded by the six cameras in a 24-hour period.
They found:
- There were 171 (37.3 percent) hand hygiene episodes recorded at type L washbasins (soap solution on the left side and moisturizer on the right side) and 288 (62.7 percent) at type R washbasins (soap solution on the right side and moisturizer on the left side).
- Nearly all (412 of the 420 observations, or 98.1 percent) of the intended hand hygiene episodes were performed correctly using a soap-based solution.
- The correct hand hygiene product was used for 412 of the 439 of the observed hand hygiene episodes, or 93.8 percent.
- Twenty-seven of the hand hygiene episodes (6.2 percent) were performed incorrectly, including:
- One episode in which moisturizer was used instead of soap
- One episode in which alcohol was used instead of soap
- Nine episodes in which only water was used (without soap solution); and
- Sixteen episodes that involved the use of two products, simultaneously.
- Most (87.5 percent) reached for the moisturizer first and then dispensed soap solution.
- Hesitation was observed for 26 hand hygiene episodes (5.8 percent). For 11 episodes, the moisturizer was applied first and then soap solution, whereas in 15 episodes the potential error was recognized prior to application, and the hands were ultimately washed with soap solution.
The study authors argue the inconsistent placement of hand hygiene products contributes to poor hand hygiene behaviors and that, conversely, standardizing their relative positioning and color and appearance would improve hand hygiene compliance.
"The standardization of the relative location of handwash solutions, such as soap on one side and hand drying agents on the other, or preferably still locating moisturizer away from soap, may improve hand hygiene behaviors," concluded the study authors.
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