Standardized Test Method to Assess the Functions and Working Characteristics of Handrub Dispensers

Abstract

Hand hygiene with Alcohol-based handrub (ABHR) is commonly employed in healthcare facilities, and dispensers are the primary means of delivering handrub during hospital work. The reliable dosing of these dispensers is a crucial, yet understudied issue. The volume of the handrub had a large impact on the quality of hand hygiene. In our experience involving human subjects, it was hard for the subjects to quantify the dispensed volume: people could not perceive if the dispenser provided inadequate volume. This article aims to establish a standardized method, summarize the parameters and approaches through which dispenser reliability shall be assessed. The new protocol was tested on a range of existing ABHR dispenser to demonstrate its versatility. 13 different marketed dispensers were investigated in this study, and both liquid and gel format handrubs were tested whenever feasible. The test protocol addresses the measurement of various parameters, including dispensed volume, accuracy, consistency, time dependency, energy consumption, sensor activity, the impact of handrub level and dosing during run-out phase. In the case of most tested dispensers, the actual dosed volume was below 1.5 ml, below the recommended minimum. Dispensed volume could be legitimately different when different handrub formats (liquid or gel) are used. Some dispensers did not provide consistent doses when they were not in operation for an extended period of time. Remarkably, after just 5 minutes of non-use, some dispensers reduced the dispensed volume by half. The time- dependent decrease varied among product formats. Detection activity showed considerable variations, one dispenser checked for hands seven times more than another. With decreased handrub level, the volume may increase or decrease, depending on the construction. The assessment protocol was established and proven in practice. There was no perfect dispenser found, critical issues have been identified with the help of the structured measurements. Given the diverse needs of hospital wards, a standardized, comparable description and assessment of dispenser characteristics could assist wards in selecting the most suitable dispenser. This study encourages manufacturers to conduct these product tests and share their results along the open science principles.