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

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

We included studies, in which the accessibility of different locations of the antiseptic hand rub dispenser inside Fig. 1 Flow diagram of the study selection process for studies examining the impact of the accessibility of the antiseptic hand rub dispenser's location on hand hygiene compliance the patient's room were evaluated with regard to the hand hygiene compliance rate or agent consumption volume. The hand hygiene compliance rate was measured as the percentage of performances counted through direct observation or counted indirectly through agent consumption. Studies investigating hand washing without an antiseptic agent did not meet our inclusion criteria. Additionally, we eliminated studies, which monitored the effect of multimodal intervention programs, or which did not examine the accessibility of the hand rub dispenser inside the patient's room, for example poster campaigns, staff audits or visual design tools such as signs or lights. Additional studies that we eliminated examined the effect of different dispenser locations associated with an introduction of hand hygiene measures, or investigated dispenser locations outside the patient room, for example on the ward corridor, in the operating theatre, or within the examination room.