Healthcare-associated infections (HAIs) affect over 1.7 million people each year, and subsequently cost the U.S. economy approximately $8.2 billion each year. Hand hygiene compliance (HHC), which involves washing hands thoroughly with alcohol-based rubs or soap and water, is widely regarded as a major prevention measure against the transmission of pathogens that cause HAIs. Even small increases in HHC have been found to reduce HAI rates in healthcare facilities. Hand sanitizing stations (HSSs) are spaces outfitted with hand hygiene resources for hospital staff and, in some cases, visitors. There is no general consensus on where HSSs should be located, since each facility has different designs and staff workflows. Since poorly located HSSs can result in reduced HHC, the authors of this study propose the development of an automated approach to choosing optimal HSS placement through the use of quantitative data.
To assess whether computer-simulated visibility and global traffic flow scores influence how frequently hand sanitizing stations are used.
The researchers developed computer-simulated layouts of three units (medical-palliative care, neonatology, and cardiac intensive care units) within a community hospital. Over the course of two weeks, instances of HSS usage in each of the units (71 HSSs total – evenly divided between the units less one in the medical-palliative care unit) were recorded via electronic devices. Behavioral observations were then conducted at 77 different HSSs for 20 hours each. Space syntax was used to assign “visibility scores” to each HSS and other room features, which were used to calculate “global traffic flow” throughout the studied areas.
The results supported the authors’ hypothesis that higher visibility scores were related to increased HSS use, while lower visibility scores were correlated with less HSS use. Similarly, higher global traffic floor scores were related to increased HSS use. This indicates that using space syntax analysis, visibility scores, and global traffic flow scores may help designers accurately predict which areas may receive increased foot traffic and subsequently allocate resources such as HSSs within the ideal areas.
The authors note the following limitations in this study. Other variables that may influence HSS use beyond spatial configurations alone, such as unpredictable environmental, social, and psychological decisions and factors, were not considered. Facility policies, protocols, and educational regiments regarding hand hygiene were not considered. The two weeks during which all data were gathered may not accurately reflect HSS use over longer periods of time.