Sourcing those hand hygiene stations, and procuring the sanitizer to fill them, proved to be quite a challenge in early 2020. But eventually supply chains eased as manufacturers located more plastic for packaging and the chemical compounds that make up hand sanitizer.

Patterson notes that finding hand sanitizing stations and supplies can be relatively easy when working through local distributors, adding that the popularity of the stations prior to COVID-19 made the supply already greater than other equipment.

Making sure hand sanitizing stations are strategically placed is just as important as having them available at all. In fact, some studies say that optimizing dispenser placement can increase usage by more than 50 percent. Simply increasing the number of dispensers has a smaller impact.

A workflow study can help optimize sanitizing station placement in any particular healthcare setting. After all, every building is different. However, some constants remain. Common sense placement options include heavily-trafficked entrances, lobbies, waiting rooms, nurses’ break rooms and outside restroom doors.

That last location might seem like overkill — restroom users hopefully just washed their hands with soap and water — but it actually makes perfect sense.

“With sanitizer available right outside the restroom, users can sanitize their hands if they had to touch the door handle to get out,” says Hicks.

Elevator lobbies are another good area for a sanitizing unit. That is because often-touched elevator buttons are covered in germs, according to a report published in Open Medicine. The study suggests hand sanitizing units be placed outside elevators so users can clean their hands after exiting.

Cafeterias offer more fertile ground for hand sanitizing. Hicks suggests putting stations at the end of the line, after money or debit/credit cards have been handled and put away to allow one last hand-sanitizing opportunity prior to eating.

But one of the most important places for a sanitizing unit is right in the patient rooms — and it’s important that patients see staff use the equipment.

“We have it at the door so patients can see you foam in and foam out as you enter and exit the room,” says Bristol. “This way patients can be assured that staff is doing their part to keep them safe.”

Hand Hygiene Disclaimers

While effective against many pathogens, hand sanitizers do not protect against everything. Hicks points out that C.diff falls into this category, and it’s because sanitizers cannot break the hard outer surface of the C.diff spore.

“If there is a case of C.diff, we actually take the sanitizer off the wall and remove any sanitizer bottles from the area,” says Hicks.

The reason it’s removed is to encourage handwashing. He adds that soap and water cannot kill C.diff either, but the friction of rubbing hands and running them under a stream of water will wash the spores away.

When soap and water is available, experts agree that handwashing is the best protection from pathogens. But if handwashing is not an option, sanitizers are key.

When citing sanitizing locations, cleaning managers should be mindful of the users. According to recent reports, emergency rooms are treating seven times the number of children with sanitizer in their eyes. Kids are either rubbing their eyes after applying sanitizer, or they are getting accidentally squirted in the eye when using the dispenser. Either way, the result can be painful and could cause permanent damage or blindness.

Solving this issue may be problematic. Sanitizing stations have to be placed low enough to meet Americans with Disabilities Act guidelines, which is unfortunately right at a small child’s eyeline.

Moisturizing Matters

Despite the myriad benefits of handwashing and sanitizing, there is a downside — red, chapped hands. Chapped hands present two distinct dangers, Hicks notes. One, a person with irritated skin will stop washing or sanitizing, increasing the chance of passing on an infection. Or, two, they will push on and continue to wash and sanitize, making the chapping worse.

“Chapping creates openings in the skin,” says Hicks. “Those openings make it easier for pathogens to pass through. That means moisturizing is really important.”

But not all moisturizer is created equal. It’s important to not grab just any moisturizer from home or a grocery store shelf. Some of these products may contain ingredients that break down protective gloves or counteract the effectiveness of the sanitizer, says Bristol.

The best strategy is to choose a hospital-approved product instead, as many hand sanitizer manufacturers produce a compatible lotion. Or, supply sanitizers that include emollients and lotions that reduce drying. According to Gerba, many manufacturers offer reformulated sanitizing options that minimize the drying of hands.

While product selection is key, even the most effective options can be rendered useless without proper maintenance. Sanitizing stations need to be cleaned just like any other piece of equipment in a healthcare setting, says Hicks. Just how often they are cleaned depends on the type of equipment and where it is placed.

Battery-operated, touchless stations should be wiped down at least once a day, Gerba notes, but stations with a push handle need more attention. Hicks recommends that each housekeeping shift disinfect the handle of a sanitizing station in a high-traffic area at least three times per day.

Sufficient handwashing habits are a key component to preventing the spread of countless HAIs. To encourage compliance, cleaning departments must strategically place hand hygiene equipment, properly maintain this equipment and select the right types of soaps and sanitizers.

Amy Milshtein is a freelancer based in Portland, Oregon.

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Hand Hygiene Tips For Healthcare Facilities