Graphic animation of the localisation of hand disinfection dispenser in a patient room Graphic animation of the localisation of hand disinfection dispenser in a patient room

Placement of disinfectant dispensers

Practical experience: Observe workflows and locations!

Recent data show that up to 6.5% of hospitalised patients in Europe and the USA are affected by healthcare-associated infections (HAIs) [1-3], which can lead to prolonged hospitalisationand increased consumption of antibiotics [4]. While improving hand hygiene (HH) could reduce infection rates, HH assessment is time consuming and not always objective. Electronic tools can now be used to generate comprehensive and objective data. Therefore, a recent study investigated the site-specific use of wall-mounted and point-of-care dispensers using the electronic HH monitoring system NosoEx® on 17 wards in nine German hospitals [5].

Intensive care units lead in number of dispensers and disinfections

The study anonymously recorded the rub volume of 931,446 hand disinfections and analysed the number and rub volume of wall-mounted and point-of-care dispensers by ward and room type. It was found that intensive care units (ICUs), intermediate care units (IMCs) and neurological wards had more dispensers than, for example, orthopaedic surgical wards, with wall-mounted dispensers dominating overall (see figure). In addition, ICUs and IMCs were well ahead with more than three dispensers per bed and more than 20 disinfections per patient day.

Grafic_Mean number of HRDs
Figure: Mean number of HRDs per bed by ward type and comparison of POC and WMD numbers on individual wards. Bars show the averages of POCs and WMDs per ward type, while circles (WMD) and triangles (POC) show the individual numbers of HRDs per ward. Vertical lines indicate recommendations of German KRINKO (0.5 HRDs/bed on normal wards and one HRD/bed on ICU) and the number considered optimal (two HRDs/bed) [7]. ICU, intensive care unit; IMC, intermediate care; POC, point-of-care dispenser; WMD, wall-mounted dispenser.

Hand rub dispenser use is location-dependent

Interestingly, the study also showed that it is not just the number of dispensers that matters, but also where they are located and how they are used. For example, dispensers were more likely to be used in high-traffic areas such as hallways. It was also confirmed that hand disinfection is most reliable when there is a risk of exposure to infectious agents. Dispensers placed in patients' rooms were most commonly used on surgical wards, presumably because contact with open wounds is unavoidable. In addition, the highest volume of rub per disinfection (3.6 mL) was found in treatment rooms.

Consider dispenser placement and workflow for optimal use

The results suggest that dispenser use is influenced by room type, as well as ward type and workflow. Therefore, neither simply increasing the number of dispensers nor optimising their placement may be the only solutions to improve HH compliance. Digital monitoring systems that provide accurate and location-specific usage data can be used to objectively analyse the overall picture. In the future, this could lead to more specific recommendations for groups of healthcare workers and room configurations.
Poster showing the results of a study about digital hygiene monitoring


  1. Magill SS et al. (2018) N Engl J Med 379: 1732-1744.
  2. BARMER Krankenhausreport 2021. (accessed on 21.03.2024)
  3. Suetens C et al. (2018) Eurosurveillance 23: 1800516.
  4. Haque M et al. (2018) Infect Drug Resist 11: 2321-2333.
  5. Senges C et al. (2024) Infection Prevention in Practice6:2:100364.
  6. Kuster S et al. (2021) Antimicrob Resist Infect Control 10: 93.
  7. Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Händehygiene in Einrichtungen des Gesundheitswesens (2016) Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 9: 1189-1220. (accessed on 21.03.2024)

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