BACKGROUND Handwashing is a key barrier to cross-infection performed at a handwash station (HWS). Elbow-operated outlets, if used incorrectly (with hands), become highly touched objects, potentially providing a route for cross-infection. AIM To study how elbow-operated outlets were used by staff in this hospital, whether the correct type of HWS had been installed in the various ward areas according to the Health Building Note (HBN) 00-10 Part C: Sanitary Assemblies (hands-free outlets in clinical, food preparation and laboratory areas), and factors impinging on design/setup which may affect compliance with correct use. METHODS Observation of outlet use was performed by mounting a video camera above four HWSs. Review of suitability of outlet was conducted by two of the authors by visiting ward areas and assessing compliance against HBN recommendations. Angle of elbow-operated lever setup was measured using a protractor and water temperature in relation to angle of movement of elbow lever was measured using a calibrated thermocouple. FINDINGS Ninety-two percent of staff used hands to turn on the outlet and 68% used hands to turn the outlet off, potentially re-contaminating their hands. More than 70% of users moved the lever ≤45°. Almost half of elbow levers were set up incorrectly, being flush or within 3.5 cm of the rear panel, making elbow operation extremely difficult. Selection of outlet type according to HBN was most incorrect in the intensive treatment unit but also occurred in the newly built parts of the hospital. CONCLUSIONS Although handwashing is a key barrier to cross-infection, poor selection and incorrect use of outlet undermines its effectiveness. Design and incorrect instalment further compromise the intended means of operation of elbow levers. Of equal concern is that this risk mostly goes unrecognized. There is an opportunity to improve handwashing safety, but it requires engagement across a broad stratum from Government Departments of Health and manufacturers down to the user.

中文翻译：

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从交叉感染/使用者的角度对出水口设计进行的观察研究：是时候进行彻底的重新思考了吗？

背景技术洗手是在洗手站（HWS）进行交叉感染的关键障碍。肘部操作的出水口，如果使用不正确（用手），将成为高度接触的物体，从而可能为交叉感染提供途径。目的为研究该医院工作人员如何使用肘部出口，是否根据卫生建筑说明（HBN）00-10 C部分：卫生组件（手-免费的临床，食品制备和实验室区域网点）以及影响设计/设置的因素，这些因素可能会影响正确使用的依从性。方法通过将摄像机安装在四个HWS上方来观察插座的使用情况。两位作者通过访问病房区域并评估对HBN建议的遵守情况，对出口的适用性进行了审查。使用量角器测量肘杆的角度，并使用校准的热电偶测量水温与肘杆运动角度的关系。调查结果有92％的员工用双手打开电源插座，有68％的员工用双手关闭电源插座，可能会再次污染他们的手。超过70％的用户将操纵杆移动了≤45°。几乎一半的肘杆设置不正确，齐平或在后面板的3.5厘米以内，这使得肘部操作极为困难。在强化治疗室中，根据HBN选择出口类型最不正确，但在医院的新建部分中也是如此。结论尽管洗手是交叉感染的主要障碍，但选择不当和错误使用出口会削弱其有效性。设计和不正确的安装进一步损害了肘杆的预期操作方式。同样令人担忧的是，这种风险大都无法得到认识。有机会提高洗手的安全性，但这需要从卫生部门，制造商到用户的广泛参与。