Everyone knows that good hand hygiene – including hand washing and donning gloves – is important in preventing infections in healthcare settings. So is the infrastructure that supports it – sinks, faucets and soap and alcohol rub dispensers.
Here are some things you might not know about water and related topics, as they pertain to healthcare-acquired infections.
- The location of sinks is more influential than the number of sinks. One study found that each additional meter between the patient’s immediate surroundings and the nearest sink decreased the likelihood of handwashing by 10 percent.
- Pathogens can be spread by water splashed from sinks, so water pressure should be optimized and flow should be offset from the drain.
- Sinks designated for handwashing, and not for patient use, can improve hygiene, some studies show.
- It’s true that valves in faucets that automatically turn on and off by themselves can reduce transmission of pathogens by negating the need for users to touch the handle. But they also have low flow, tepid temperature and internal components (valves) that may harbor biofilm, which can contribute to microbial amplification.
- Paper towels are preferable to warm-air blowers for drying hands, because the towels can be used to turn off the faucet after use and the blowers may spread pathogens. But be careful: Pathogens can be spread by contaminated towel dispensers.
- Alcohol-based hand rub dispensers have been shown to improve hand hygiene compliance. The optimal location appears to be just outside the doorways to patient rooms. In that location, the dispenser is highly visible and is on the route of the caregiver; the action of entering the room is a trigger for the caregiver to perform hand hygiene.
- Dispensers immediately near or on patient beds also help compliance.
- The design of dispensers is important: A bright color and a design that differentiates the hand rub dispenser from soap dispensers improve usage.
- Plumbing in a healthcare facility can house pathogens. In fact, completely eliminating those pathogens is unlikely. A multidisciplinary water management team should be appointed with the authority to implement water decisions. These include mapping the water system; analyzing hazards; developing mitigation strategies; establishing metrics; enacting policies that identify hazards; conducting surveillance for disease caused by waterborne pathogens (e.g., pneumonia, bloodstream infections, surgical site infections, meningitis, gastroenteritis and urinary tract infections); and developing a strategy for replacement of current higher-risk premise plumbing problem areas.
- One more thing about water: Those beautiful, soothing, in-hospital water features – water walls, reflecting pools, fountains? Pretty to look at, but avoid them. They represent unacceptable risk in hospitals serving immunocompromised patients, even with standard maintenance and sanitizing methods.
Source: “Using the Health Care Physical Environment to Prevent and Control Infection,” a joint project prepared for the Centers for Disease Control and Prevention by the American Society for Health Care Engineering and several other organizations. (http://www.ashe.org/resources/pdfs/cdc/CDCfullbookDIGITAL.pdf)