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Standard Process Handwashing System in Patient Rooms; All new patient care units

September 2012
EDAC Advocate Firm Project
Harley Ellis Devereaux


Firm's role on the project:  Planning, Programming, Architecture, Design, Interiors 

EBD Goal

To create a standard process that facilitates appropriate hand washing practice prior to caregiver interaction with the patient.



The World Health Organization states that nosocomial infections affect roughly 1.7 million patients in the United States each year, racking up an annual cost of $6.5 billion and contributing to more than 90,000 annual deaths. This epidemic is an operational issue within hospitals and a challenge that the design community can help address by design.. As insurance companies change policies and refuse to cover the time needed in the hospital to recover from the hospital associated infection, facilities should start to look at their procedures and policies.

The challenge facing both the design community and hospitals, is that the definition of a well-designed standard process for basic hand washing is variable and changes with every institution. Developing a standard process for hand washing may help address the issue.


Three hypotheses drove the design; first, creating a standard one direction flow for the caregiver leads to better compliance, second, easy viewing of the hand washing process by the patient/family may lead to better satisfaction scores (“observing staff washing hands”), and third, placing the hand washing accessories on an equipment rail allows adjustment in the system without creating damage to the wall and potential home for pathogens. The outcome of meeting these goals may lead to a reduction of nosocomial infections through direct caregiver to patient contact.

The project team including the infection control representative, nurses, administrators, and the design team, developed a process that facilitated the appropriate procedure for hand washing. It was very important for  gloves not to be the first item on the wall when entering the room as this could be a staff’s  attempt at “sterilizing.” At room entry the proposed proper sequence is hand sanitization, soap, sink, paper towel, and then gloves. The process is viewable by the patient and family, and this design also facilitates an exit strategy with the linen and trash hampers at the door and the hand sanitizer in close proximity to be used prior to exiting the room.