Sink location MATTERS!


“Hand hygiene with soap and water after the care of a patient with Clostridium difficile infection is essential to reduce nosocomial transmission in an outbreak situation.”

A recent study in the American Journal of Infection Control has highlighted the need for visible, easily accessible sinks to increase the performance rate of hand washing and infection control.

The study focussed on the low hand hygiene compliance rate at an institution with regards to Clostridium difficile infection.  It identified access to a lack of a readily visible and accessible sinks as a major barrier to hand hygiene compliance.

No plumbing sink at the point of need

The quantitative study measured the impact that sink placement had on hand hygiene compliance rates.  It found that although there were 36 sinks on the unit before the intervention, and all except two were in patient rooms, they were generally “not used by health care workers because of patient clutter, lack of access because of the presence of furniture, or general unfamiliarity with the patient room layout.”  It found that it was “difficult to minimize clutter around the existing sinks” because of the length of stay of most patients with Clostridium difficile infection.  Furthermore the two hallway sinks were not readily visible from most patient rooms.

As part of the study, 2 additional sinks were subsequently placed in highly visible, optimised locations based on workflow.

The following results were recorded:

  • Overall, contact precaution compliance increased 22% after the intervention, from 13% to 35%.
  • The number of individuals who were partially compliant reduced from 57% to 35%.
  • Completion of proper hand hygiene on exiting the CDI patient room improved by 18%.
  • The number of individuals who failed to perform any hand hygiene after being in a CDI patient room decreased from 54% to 37%.
  • After the intervention, the number of individuals who performed proper hand hygiene prior to entering the patient room increased by 19%.
  • The percentage of individuals who failed to perform any hand hygiene before entering the patient room was reduced by 21%.

It was also noted:

  • The sink closer to the nurses station was within easy range of most of the patient rooms and was the one that was the more heavily used.
  • Staff showed a high level of satisfaction, and they reported that the 2 new visible sinks enhanced the likelihood of completing proper hand hygiene on exiting the patient room.

The study concluded that “limitations notwithstanding, health care workers on this unit housing severely immunocompromised patients had an increased incidence of handwashing with additional sinks being placed. Systems assessment and interventions to reduce systems barriers are essential to improving health care worker and visitor compliance with a complex behavioral intervention, such as hand hygiene for the care of a patient with CDI.”

Zellmer, C., Blakney, R., Van Hoof, S., & Safdar, N. (2015). Impact of sink location on hand hygiene compliance for Clostridium difficile infection. American journal of infection control.  Available here.