Conspicuous vs customary location of hand hygiene agent dispensers on alcohol-based hand hygiene product usage in an intensive care unit

J Am Osteopath Assoc. 2009 May;109(5):263-7; quiz 280-1.


Context: Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities.

Objectives: To determine whether placement of hand hygiene foam dispensers in more conspicuous positions and closer proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume.

Methods: This prospective, observational study conducted in an intensive care unit was composed of three observation periods. A control period with standard agent dispenser location (8 dispensers) was followed by two experimental periods: (1) "conspicuous and immediate proximity to patient" placement (16 dispensers) and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers).

Results: Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a statistically significant increase in daily consumption after conspicuous and proximate positioning of dispensers (P<.001). However, increasing the number of dispensers did not increase agent use (P=.196).

Conclusion: More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie, immediate proximity to patients) resulted in statistically and clinically significant increases in product usage. An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on usage by volume for these highly effective products should be considered when planning and implementing intensive care unit infection-control policies.

MeSH terms

  • Alcohols / administration & dosage*
  • Anti-Infective Agents, Local / administration & dosage*
  • Attitude of Health Personnel
  • Cross Infection / prevention & control*
  • Disinfection / methods
  • Disinfection / statistics & numerical data*
  • Guideline Adherence
  • Hand Disinfection* / methods
  • Health Knowledge, Attitudes, Practice
  • Health Promotion
  • Humans
  • Intensive Care Units*
  • Prospective Studies
  • Social Marketing
  • United States


  • Alcohols
  • Anti-Infective Agents, Local