Hand hygiene can only be efficient if the whole hand surface is treated with sufficient alcohol-based handrub (ABHR); therefore, the volume of handrub applied is a critical factor in patient safety. The proper amount of ABHR should be provided by handrub dispensers. The aim of this study was to investigate the dispensing performance of wall-mounted ABHR dispensers commonly employed in hospital settings. In a multicenter study, we tested 46 dispensers (22 in laboratory and 24 in clinical environments), measuring dispensed ABHR volume during continuous use and after a period of non-use. The influence of the pumping mechanism, liquid level, ABHR formats, handrub composition, temperature, and atmospheric pressure was investigated. A total of 7 out of the 22 investigated dispensers (32%) lost a significant amount of handrub; greater than 30% of the nominal volume after 8 h of non-use, thus frequently dispensing suboptimal volume, as measured in laboratory settings. Key influencing factors were found to be handrub format (gel or liquid), handrub level in the container and type of dispenser. When gel ABHR was used, after 4 h of non-use of the dispensers, the volume of the dispensed amount of ABHR insignificantly changed (97% of the original amount), while it technically decreased to zero in the case of liquid ABHR (1% of the original amount). The liquid level had a medium effect on the dispensed volume in each investigated case; the magnitude of this effect varied widely depending on the dispensing mechanism. When dispensers were in continuous use, they dispensed a cumulated 3 mL of ABHR from two consecutive pushes, while when they were not in use for 1 h, up to 4 consecutive pushes were necessary to provide a total of 3 mL ABHR. Design and production quality were also identified as important contributing factors with respect to the volume dispensed. Data collected in clinical settings confirmed these findings, for multiple types of dispensers. All ABHR dispensers should be regularly audited to control the reference volume distributed, with particular attention paid to regular mechanical pump units filled with liquid handrub.

中文翻译：

---

普通类型的酒精型洗手液分配器的关键可靠性问题。

仅当整个手部表面都经过足够的酒精基手搓（ABHR）处理后，手部卫生才有效。因此，所用的手揉搓量是患者安全的关键因素。应当由洗手液分配器提供适量的ABHR。这项研究的目的是调查医院环境中常用的壁挂式ABHR分配器的分配性能。在一项多中心研究中，我们测试了46个分配器（实验室为22个，临床环境为24个），在连续使用和不使用一段时间后测量分配的ABHR量。研究了泵送机理，液位，ABHR格式，洗手液成分，温度和大气压的影响。在22个被调查的分配器中，共有7个（32％）损失了大量的手磨；闲置8小时后，其体积会超过标称体积的30％，因此经常分配次最佳体积（如实验室设置所测）。发现主要的影响因素是洗手液形式（凝胶或液体），容器中的洗手液水平和分配器的类型。当使用凝胶ABHR时，在不使用分配器4小时后，ABHR的分配量几乎没有变化（原始量的97％），而在液体ABHR的情况下从技术上减少到了零（1原始金额的百分比）。在每个调查案例中，液位对分配量都有中等影响；这种影响的大小取决于分配机制而有很大的不同。连续使用分配器时，他们两次连续推入分配了3 mL的ABHR，而在闲置1小时后，最多需要连续4次推动才能提供总共3 mL ABHR。设计和生产质量也被确定为分配量的重要贡献因素。在临床环境中收集的数据证实了针对多种类型分配器的这些发现。应该对所有ABHR分配器进行定期检查，以控制分配的参考量，尤其要注意装有液体手搓纸的常规机械泵装置。