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From the Department of Trauma/Surgical Intensive Care at Wesley Medical Center in Wichita, Kan (Drs Thomas and Vasquez, Ms Jackson), and the Department of Preventive Medicine and Public Health at University of Kansas School of Medicine – Wichita (Drs Berg-Copas and Wetta-Hall). All research for this study was conducted at the latter institution.

Address correspondence to Gina M. Berg-Copas, PhD, 1010 N Kansas St, Wichita, KS 67214-3199. E-mail: gcopas{at}kumc.edu

Context: Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities.

Objectives: To determine whether placement of hand hygiene foam dispensers in more conspicuous positions and closer proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume.

Methods: This prospective, observational study conducted in an intensive care unit was composed of three observation periods. A control period with standard agent dispenser location (8 dispensers) was followed by two experimental periods: (1) "conspicuous and immediate proximity to patient" placement (16 dispensers) and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers).

Results: Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a stastically significant increase in daily consumption after conspicuous and proximate positioning of dispensers (P<.001). However, increasing the number of dispensers did not increase agent use (P=.196).

Conclusion: More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie, immediate proximity to patients) resulted in statistically and clinically significant increases in product usage. An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on usage by volume for these highly effective products should be considered when planning and implementing intensive care unit infection-control policies.