Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis

Stiller, Andrea; Salm, Florian; Bischoff, Peter; Gastmeier, Petra

Proper hand disinfection has been proven to be one of the most effective infection control measures. It is quite conceivable that factors improving the compliance rate support the barrier against pathogen transmission [7, 8] . We did not identify any studies investigating on the impact of the location of handrub dispensers on healthcare-associated infection rates. However, the results of this review indicate that sustainable improvement of hand hygiene compliance can be supported by locating the hand rub dispenser in the point of care and facilitate its accessibility for healthcare workers [31] [32] [33] . Therefore, this review confirms the conclusions made by Kendall et al. who suggest to ensure the availability of the hand rub dispenser in the point of care [33] . Likewise, Zingg et al. concluded that a hand-rub dispenser directly in sight of healthcare workers and facilities for hand hygiene at the point of care both improved hand hygiene performance in their systematic review about hospital organization, management and structure for the prevention of HAIs [34] However, as Giannitsioti et al. found out in their follow-up study, a directly accessible dispenser alone may not lead to a sustained compliance improvement [14] . We suggest that easily accessible hand rub dispensers be placed near the patient's bed at the point of care. This should be combined with other useful compliance improvement measures such as regular staff training and feedback on compliance rates to ensure improved hand hygiene.