Infection prevention begins with fundamentals, and there is nothing more fundamental than hand hygiene. However, there is a lot of confusion in the industry regarding the placement of alcohol-based hand rub (ABHR) dispensers and even if they are allowed per the fire and safety regulations.
Some facilities have them inside resident rooms, some outside, and some scattered throughout the resident hallways. Which of these options is a best practice?
Our team has been implementing boots-on-the ground onsite visits to hundreds of nursing homes since our conception in 2017. We found that in 2021, only 30% of the nursing homes we visited had ABHR outside of the resident’s room, while 45% had it only inside of the room. This was alarming for two reasons.
One, many nursing homes were lacking in ABHR access overall, and two, the Centers for Disease Control and Prevention (CDC) recommends that nursing homes have ABHR with 60-95% alcohol inside AND outside of every resident room if possible.
One common explanation for not having ABHR inside and outside of the resident rooms is because it “violates the fire code”. However, per the Life Safety Code requirements, so long as there is not more than 10 gallons of ABHR fluid used within a corridor (smoke compartment) there can be ABHR dispensers outside of each resident room. ABHR dispensers located within resident rooms are not included in the 10-gallon figure as those are considered separate smoke compartments.
Studies show that when ABHR dispensers are located in areas where hand hygiene often needs to occur, like directly inside and outside of the resident rooms, hand hygiene compliance increases. Having easy access to ABHR to hard-wire this prevention practice is essential for nursing homes to decrease infections.
I understand that implementing additional ABHR dispensers can be a costly endeavor for a facility. However, in my experience, many vendors will supply the ABHR dispensers free of charge. Consider discussing this option with your ABHR vendor today!
Research continually demonstrates that contaminated hands are one of the easiest ways that infections are transmitted. Did you know that just washing one’s hands alone can reduce diarrhea related illnesses by 30% and respiratory infections by 20%? This in turn can reduce the amount of unnecessary antibiotic use within a facility as keep residents healthier!
To measure hand hygiene compliance, facilities should consider conducting competency and opportunity audits on a scheduled basis. A competency audit is where a staff member, such as the infection preventionist (IP), watches another staff member, such as the Certified Nursing Assistant (CNA), perform hand hygiene.
An opportunity audit is where the IP or other staff members evaluates if the staff member is conducting hand hygiene when it is appropriate such as before and after contact with a resident.
Hand hygiene seems like a no brainer and a topic that many staff members tend to brush off. However, this is by far one of the most significant ways to decrease infections within nursing homes. To encourage staff members to conduct proper hand hygiene regularly, consider hosting staff in-service training sessions using the product Glo-Germ, paint, or even chocolate pudding to demonstrate how quickly germs can spread! Thank you to all the healthcare heroes out there keeping our loved ones safe!
Buffy Lloyd-Krejci, DrPH, CIC, is the founder of IPCWell. Drawn to action to improve the infection prevention landscape for these communities, she utilized her over two decades of experience in the healthcare field and her doctorate in public health (DrPH) to launch IPCWell. Dr. Buffy and her team have provided training, education, and technical assistance (both in person and virtually) to hundreds of congregate care facilities throughout the COVID-19 pandemic.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
