Over the past few years, alcohol dispensers along with hand washing sinks have become the standard in most healthcare settings. To a large extent it seems to be a duplication of efforts. We may actually be in a transitional time where no one is comfortable with moving to the next technology and being responsible for the outcome if something should go wrong.
The jury is still out even among the experts as those from the CDC, OSHA, and American Institute of Architects (AIA) are undecided on which direction we should move in.
AIA recommends hand washing sinks in all exam rooms and patient care areas with the use of disposable towels. The CDC recommends that when needing to wash visible dirt or containment the healthcare professional should wash with soap and water. OSHA recommends both alcohol dispensers and hand washing sinks.
Some of the benefits to moving towards using more alcohol dispensers were expressed in one study that showed using alcohol-based sanitizers versus hand washing sinks would reduce the time it normally takes a healthcare professional to wash and dry their hands by 75%. Alcohol based hand sanitizers were found to be more antiseptic in all but two CDC studies and reduce bacterial counts more that soap and water in all but 4% of the cases.
One of the issues with alcohol dispensers is in the compliance of use because they are so much smaller and harder to see than a sink. An OSHA Health Care advisor states that when they are placed within the field of vision, the compliance rate is around 53.8%. When they are not in the field of vision, that rate goes down to 11.5%.
But perhaps the biggest issue of all is we have not seen a universal change to implementing fewer sinks and more alcohol dispensers. This is due to the backlash from fire marshals. Alcohol dispensers are typically Class 1 flammable with a 75 degree flashpoint. Many facilities have been cited for flammable liquids simply because they have alcohol dispensers installed, which has created quite a disturbance between infection control professionals and fire marshals. While guidelines for using alcohol dispensers have finally been developed, the code itself is still left up to the individual states.
Until a universal fire code happens, the movement toward more alcohol dispensers in healthcare will most likely not progress.