Localisation of indication-based hand desinfections.

Questions: Does the location of disinfectant dispensers (DD) influence its usage for hand disinfection? Is the type of medical indication decisive for using a certain DD in respect to its location? Is it possible to define favourable and unfavourable positions of DD in a patient room by an electronic monitoring system (EMS)?
Methods: Study was from Feb.2022-Dez.2023, with direct observations (dO) by staff on 3 wards (ICU, IMC, Normal). dO included the localisation of indication-based HD, distinguishing between patient room and outside. We also applied an EMS (NosoEx® GWA Hygiene, Paul Hartmann AG) permanently recording HD. EMS data were sorted as dO data but further specified adressing DD types and locations in patient room. DD types: wall mounted, freestanding, hanging. Raw data were processed by TU Dortmund.
Results: We analysed 1324 dO seeing most HD executed in patient room with 72,2%, 67,9% and 84,9% for Normal, IMC and ICU, respectively. The most indications observed are after and before touching a patient and before aseptic procedures with 37.2%, 18.7% and 13.6%. Regarding the location of HD the indication before touching a patient has the lowest and after touching a patient the highest values for HD in patient room (64.2% and 86.4%). EMS recorded 985740 HD. Normal ward and ICU prefer HD in patient room with 77% and 71%, while IMC executes less HD inside (47%). Hanging DD in direct proximity to patient beds are preferred for HD on Normal ward (70%). On IMC and ICU hanging DD placed at the window side were not used frequently (16% and 5 %). Both, IMC and ICU execute most HD with wall mounted DD (56% and 79%).
Conclusions: Here, the type of medical indication does not obviously influence the location of HD. However, the positions of DD have great impact on frequency of its use. Striking are here the two analysed locations of hanging DD. Further, is the position of a DD more crucial than its type. Nevertheless, when it comes to the integration in the health care workflow and acceptance by the medical staff, type and handling might be mandatory. We want to point out, that the conditions on each ward are unique and must be assessed individually.