Review article| Volume 40, ISSUE 4, SUPPLEMENT , S3-S10, May 2012

Download started.


Point-of-care hand hygiene: Preventing infection behind the curtain

      Best practices for hand hygiene provide indications for performance of hand hygiene at specific points in time during patient care. For hand hygiene to prevent infections, hand hygiene resources must be readily available to health care workers whenever required. This article reviews practices and recommendations intended to facilitate hand hygiene behavior at the point of care (POC) within the health care setting. Key aspects of POC hand hygiene include the provision of alcohol-based hand rub products, integration of dispensing solutions within the patient zone, consideration of patient care workflow, and dispenser designs that optimize acceptance and usage.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        WHO guidelines on hand hygiene in health care.
        World Health Organization, Geneva [Switzerland]2009
        • Centers for Disease Control and Prevention
        CDC guideline for hand hygiene in healthcare settings.
        Centers for Disease Control and Prevention, Atlanta [GA]2002
        • Joint Commission
        Measuring hand hygiene adherence: overcoming the challenges.
        The Joint Commission, Oakbrook Terrace [IL]2009
        • World Health Organization
        Guide to implementation of the WHO multimodal hand hygiene improvement strategy.
        World Health Organization, Geneva [Switzerland]2009
        • Pittet D.
        Improving adherence to hand hygiene practice: a multidisciplinary approach.
        Emerg Infect Dis. 2001; 7: 234-240
        • Sax H.
        • Allegranzi B.
        • Uckay I.
        • Larson E.
        • Boyce J.
        • Pittet D.
        “My five moments for hand hygiene”: a user-centred design approach to understand, train, monitor and report hand hygiene.
        J Hosp Infect. 2007; 67: 9-21
        • Mathai E.
        • Allegranzi B.
        • Kilpatrick C.
        • Pittet D.
        Prevention and control of health care–associated infections through improved hand hygiene.
        Indian J Med Microbiol. 2010; 28: 100-106
      1. Dartmouth-Hitchcock Hospital. The Dartmouth-Hitchcock nest concept for hand hygiene. Available from: Accessed January 17, 2012.

        • Pittet D.
        • Boyce J.
        Hand hygiene and patient care: pursuing the Semmelweis legacy.
        Lancet Infect Dis. 2001; 1: 9-20
        • Hedrick E.
        • Hamory B.
        • Peterson-Homer L.
        The effect of providing a rinseless handwashing agent at the bedside in modifying handwashing frequency.
        Am J Infect Control. 1987; 15 ([poster abstract]): 93
        • Voss A.
        • Widmer A.F.
        No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance?.
        Infect Control Hosp Epidemiol. 1997; 18: 205-208
        • Pittet D.
        • Mourouga P.
        • Perneger T.V.
        Infection Control Program. Compliance with handwashing in a teaching hospital.
        Ann Intern Med. 1999; 130: 126-130
        • Pittet D.
        • Hugonnet S.
        • Harbarth S.
        • Mourouga P.
        • Sauvan V.
        • Touveneau S.
        • et al.
        Infection Control Programme. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene.
        Lancet. 2000; 356: 1307-1312
        • Pittet D.
        • Sax H.
        • Hugonnet S.
        • Harbarth S.
        Cost implications of successful hand hygiene promotion.
        Infect Control Hosp Epidemiol. 2004; 25: 264-266
        • Son C.
        • Chuck T.
        • Childers T.
        • Usiak S.
        • Dowling M.
        • Andiel C.
        • et al.
        Practically speaking: rethinking hand hygiene improvement programs in health care settings.
        Am J Infect Control. 2011; 39: 716-724
        • Forrester L.A.
        • Bryce E.A.
        • Mediaa A.K.
        Clean Hands for Life: results of a regional hand hygiene campaign.
        Am J Infect Control. 2008; 36 ([poster abstract]): E70
      2. Australian Commission on Safety and Quality of Healthcare, World Health Organization. Hand Hygiene Australia: 5 Moments for Hand Hygiene. 2010 Nov. Available from: Accessed January 18, 2012.

      3. Ontario Agency for Health Protection and Promotion. Just clean your hands: your 4 moments for hand hygiene. Available from: Accessed January 17, 2012.

      4. World Health Organization. Clean care is safer care. Available from: Accessed January 17, 2012.

      5. Joint Commission Center for Transforming Healthcare. The hand hygiene project. 2009. Available from: Accessed January 18, 2012.

        • Pittet D.
        • Allegranzi B.
        • Sax H.
        • Dharan S.
        • Pessoa-Silva C.L.
        • Donaldson L.
        • et al.
        Evidence-based model for hand transmission during patient care and the role of improved practices.
        Lancet Infect Dis. 2006; 6: 641-652
        • Korniewicz D.M.
        • Garzon L.
        • Seltzer J.
        • Feinleib M.
        Failure rates in nonlatex surgical gloves.
        Am J Infect Control. 2004; 32: 268-273
        • Steed C.
        • Kelly J.W.
        • Blackhurst D.
        • Boeker S.
        • Diller T.
        • Alper P.
        • et al.
        Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 Benchmark Study.
        Am J Infect Control. 2011; 39: 19-26
        • Eldridge N.E.
        • Woods S.S.
        • Bonello R.S.
        • Clutter K.
        • Ellingson L.
        • Harris M.A.
        • et al.
        Using the Six Sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units.
        J Gen Intern Med. 2006; 21: S35-S42
        • Haas J.P.
        • Larson E.L.
        Impact of wearable alcohol gel dispensers on hand hygiene in an emergency department.
        Acad Emerg Med. 2008; 15: 393-396
        • Noritomi D.T.
        • Chierego M.
        • Byl B.
        • Menestrina N.
        • Carollo T.
        • Struelens M.
        • et al.
        Is compliance with hand disinfection in the intensive care unit related to work experience?.
        Infect Control Hosp Epidemiol. 2007; 28: 362-364
        • Novoa A.M.
        • Pi-Sunyer T.
        • Sala M.
        • Molins E.
        • Castells X.
        Evaluation of hand hygiene adherence in a tertiary hospital.
        Am J Infect Control. 2007; 35: 676-683
        • Scheithauer S.
        • Eitner F.
        • Mankartz J.
        • Haefner H.
        • Nowicki K.
        • Floege J.
        • et al.
        Improving hand hygiene compliance rates in the haemodialysis setting: more than just more hand rubs.
        Nephrol Dial Transplant. 2012; 27: 766-770
        • Pittet D.
        • Allegranzi B.
        • Sax H.
        Hand hygiene.
        in: Jarvis W.R. Bennett & Brachman’s hospital infections. 5th ed. Lippincott Williams & Wilkins, Philadelphia [PA]2007: 31-44
        • Thomas B.W.
        • Berg-Copas G.M.
        • Vasquez D.G.
        • Jackson B.L.
        • Wetta-Hall R.
        Conspicuous vs customary location of hand hygiene agent dispensers on alcohol-based hand hygiene product usage in an intensive care unit.
        J Am Osteopath Assoc. 2009; 109: 263-267
        • Cochrane J.
        Infection control audit of hand hygiene facilities.
        Nurs Stand. 2003; 17: 33-38
        • Koff M.D.
        • Corwin H.L.
        • Beach M.L.
        • Surgenor S.D.
        • Loftus R.W.
        Reduction in ventilator-associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program.
        J Crit Care. 2011; 26: 489-495
        • Larson E.L.
        • Albrecht S.
        • O’Keefe M.
        Hand hygiene behavior in a pediatric emergency department and a pediatric intensive care unit: comparison of use of 2 dispenser systems.
        Am J Crit Care. 2005; 14: 304-311
        • Feinstein K.W.
        • Grunden N.
        • Harrison E.I.
        A region addresses patient safety.
        Am J Infect Control. 2002; 30: 248-251
        • Lin L.
        • Vicente K.J.
        • Doyle D.J.
        Patient safety, potential adverse drug events, and medical device design: a human factors engineering approach.
        J Biomed Inform. 2001; 34: 274-284
        • Suresh G.
        • Cahill J.
        How “user friendly” is the hospital for practicing hand hygiene? An ergonomic evaluation.
        Jt Comm J Qual Patient Saf. 2007; 33: 171-179
        • Chagpar A.
        • Banez C.
        • Lopez R.
        • Cafazzo J.A.
        Challenges of hand hygiene in healthcare: the development of a tool kit to create supportive processes and environments.
        Healthc Q. 2010; 13: 59-66
        • Giannitsioti E.
        • Athanasia S.
        • Antoniadou A.
        • Fytrou H.
        • Athanassiou K.
        • Bourvani P.
        • et al.
        Does a bed rail system of alcohol-based handrub antiseptic improve compliance of health care workers with hand hygiene? Results from a pilot study.
        Am J Infect Control. 2009; 37: 160-163
        • Birnbach D.J.
        • Nevo I.
        • Scheinman S.R.
        • Fitzpatrick M.
        • Shekhter I.
        • Lombard J.L.
        Patient safety begins with proper planning: a quantitative method to improve hospital design.
        Qual Saf Health Care. 2010; 19: 462-465
        • Lankford M.G.
        • Zembower T.R.
        • Trick W.E.
        • Hacek D.M.
        • Noskin G.A.
        • Peterson L.R.
        Influence of role models and hospital design on hand hygiene of healthcare workers.
        Emerg Infect Dis. 2003; 9: 217-223
        • Boyce J.M.
        • Pittet D.
        Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
        Infect Control Hosp Epidemiol. 2002; 23: S3-40
        • Marra A.R.
        • Guastelli L.R.
        • de Araujo C.M.
        • dos Santos J.L.
        • Lamblet L.C.
        • Silva Jr., M.
        • et al.
        Positive deviance: a new strategy for improving hand hygiene compliance.
        Infect Control Hosp Epidemiol. 2010; 31: 12-20
        • Johnson P.D.
        • Martin R.
        • Burrell L.J.
        • Grabsch E.A.
        • Kirsa S.W.
        • O’Keeffe J.
        • et al.
        Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection.
        Med J Aust. 2005; 183: 509-514
        • Creedon S.A.
        Healthcare workers’ hand decontamination practices: compliance with recommended guidelines.
        J Adv Nurs. 2005; 51: 208-216
        • Larson E.
        • Girard R.
        • Pessoa-Silva C.L.
        • Boyce J.
        • Donaldson L.
        • Pittet D.
        Skin reactions related to hand hygiene and selection of hand hygiene products.
        Am J Infect Control. 2006; 34: 627-635
        • Mah M.W.
        • Deshpande S.
        • Rothschild M.L.
        Social marketing: a behavior change technology for infection control.
        Am J Infect Control. 2006; 34: 452-457
        • Lawton R.M.
        • Turon T.
        • Cochran R.L.
        • Cardo D.
        Prepackaged hand hygiene educational tools facilitate implementation.
        Am J Infect Control. 2006; 34: 152-154
        • Archer J.R.
        • Wood D.M.
        • Tizzard Z.
        • Jones A.L.
        • Dargan P.I.
        Alcohol hand rubs: hygiene and hazard.
        BMJ. 2007; 335: 1154-1155
        • Gormley N.J.
        • Bronstein A.C.
        • Rasimas J.J.
        • Pao M.
        • Wratney A.T.
        • Sun J.
        • et al.
        The rising incidence of intentional ingestion of ethanol-containing hand sanitizers.
        Crit Care Med. 2012; 40: 291-294
        • Ouren D.
        • Tismer S.
        Evaluation of a new flexible mounting dispenser to improve point of care product access in an acute care hospital and the resulting effect on hand hygiene compliance rates.
        Am J Infect Control. 2010; 38 ([poster abstract]): E61
        • Le T.A.
        • Dibley M.J.
        • Vo V.N.
        • Archibald L.
        • Jarvis W.R.
        • Sohn A.H.
        Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam.
        Infect Control Hosp Epidemiol. 2007; 28: 583-588
        • Traore O.
        • Hugonnet S.
        • Lubbe J.
        • Griffiths W.
        • Pittet D.
        Liquid versus gel handrub formulation: a prospective intervention study.
        Crit Care. 2007; 11 ([abstract]): R52
        • Gopal R.G.
        • Jeanes A.
        • Osman M.
        • Aylott C.
        • Green J.
        Marketing hand hygiene in hospitals: a case study.
        J Hosp Infect. 2002; 50: 42-47
        • Hugonnet S.
        • Perneger T.V.
        • Pittet D.
        Alcohol-based handrub improves compliance with hand hygiene in intensive care units.
        Arch Intern Med. 2002; 162: 1037-1043
        • Maury E.
        • Alzieu M.
        • Baudel J.L.
        • Haram N.
        • Barbut F.
        • Guidet B.
        • et al.
        Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit.
        Am J Respir Crit Care Med. 2000; 162: 324-327
        • Allegranzi B.
        • Pittet D.
        Role of hand hygiene in healthcare-associated infection prevention.
        J Hosp Infect. 2009; 73: 305-315