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Visitor characteristics and alcohol-based hand sanitizer dispenser locations at the hospital entrance: Effect on visitor use rates

Originally Published:
Key Points Summary
Key Point Summary Author(s):
Dickey, Andrew
Key Concepts/Context
Proper hand hygiene is one of the most effective measures in the effort to prevent transmission of nosocomial pathogens in clinical settings. Previous studies have shown how healthcare-associated infections (HAIs) could be traced back to the spread of germs from hospital employees, patients, and visitors. While there is a large body of research on improving hand hygiene compliance among healthcare workers, there is a lack of similar studies aimed towards compliance among hospital visitors.
To examine if the use of alcohol-based hand sanitizers (AHSs) is influenced by visitor characteristics and the location of AHS dispensers within a hospital lobby.
An observational study was carried out in the lobby of a 749-bed hospital’s main visitor entrance. A black AHS dispenser on a black stand with no signage was placed in three different locations over a three-week period. These locations were chosen based on an initial assessment of trends in patient pathways throughout the main lobby, locations used in similar studies involving AHS placement, and possible saliency of the dispenser against the lobby’s décor. Two observers watched the lobby on Mondays, Wednesdays, and Sundays, twice a day from 10 a.m.-11:30 a.m. and 4 p.m.-5:30 p.m. The observers documented the assumed age, sex, group status and size, and use of AHS for each visitor.
Design Implications
To help ensure higher usage rates by hospital visitors, alcohol-based hand sanitizer dispensers could be strategically placed in locations that typically receive higher levels of foot traffic. The design of the dispenser itself should stand out among the rest of the surrounding décor, and proper signage could help promote more frequent use.
6,603 visitors were observed entering the hospital. Rates of AHS dispenser use at locations 1, 2, and 3 were 7.26%, 1.46%, and 2.53% respectively. The characteristics that affected use of the dispensers were day of the week, time of day, and visitor age. Generally, children and young adults were more likely to use AHS than all other older age groups. Visitors in the afternoon were more likely to use AHS than those in the morning. The biggest difference in use by location occurred between location 1 (in front of lobby doors in the center of an open space) and location 2 (near an information desk), where visitors were 5.28 times more likely to use the dispenser.
The authors note several limitations within this study. The study was conducted in the hospital lobby, and the placement of an AHS dispenser in this location is probably the least effective in terms of patient safety. Use of the dispenser may have been lower, as the visitors may have been planning to use a dispenser elsewhere within the hospital. Only three days out of the week were used for observations, and only a total of three hours each day. 
Design Category
Furniture, Fixtures & Equipment (FF&E)
Outcome Category
HAI related outcomes
Primary Author
Hobbs, M. A.