Background Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene practices warrant testing.

Objective To compare the frequency of use of manually operated and touch-free dispensers of sanitizer for hand hygiene.

Methods Manual and touch-free dispensers of alcohol sanitizer were placed in the emergency department and an intensive care unit of a large pediatric hospital for two 2-month periods for each type of dispenser. Counting devices installed in each dispenser and direct observations were used to determine actual frequency of and indications for hand hygiene.

Results The touch-free dispensers were used significantly more often than were the manual dispensers. The means for the number of episodes of hand hygiene per hour were 4.42 for the touch-free dispensers and 3.33 for the manual dispensers (P = .04); the means for the number of episodes per patient per hour were 2.22 and 1.79, respectively (P = .004); and the means for the number of uses of the dispenser per day were 41.2 and 25.6, respectively (P = .02). However, the overall compliance rate was 38.4% (2136 episodes of hand hygiene per 5568 indications for hand hygiene).

Conclusions The type of dispensing system influenced hand hygiene behavior. Nevertheless, overall hand hygiene compliance remained low. In order for interventions to have a major effect on hand hygiene, multiple factors must be considered.

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