Introducing a No-Touch Dispenser Dedicated to Surgical Hand Disinfection

STEPS TAKEN TO INTRODUCE NO-TOUCH DISPENSER TUD-1000

- How are hands disinfected before surgery?

In the past, the scrubbing method with antimicrobial soap was used in the hospital. But when rubbing with alcohol hand disinfectant was recommended by the Japanese Perioperative Nursing Academy, all nurses changed their practice to the new rubbing method. Some physicians did continue to practice other methods such as the scrubbing method.

- How did you come to consider installing the TUD-1000?

Since December 2017, our hospital has been using Hibiscohol A 1%, a quick-drying hand disinfectant for surgical hand preparation. Previously, we had been using an alcohol-based product containing 1% chlorhexidine gluconate ("CHG") made by another company. However, many staff members complained of sticky and rough hands, so we also used a product containing 0.5% CHG in combination with others to prevent stickiness.

Since we started using Hibiscohol A1%, there have been no concerns about stickiness or rough hands even though it contains 1% CHG, so we have decided that we do not need to use 0.5% in combination with Hibiscohol Liquid A1%, and have standardized to only one product.

With Hibiscohol A1%, we found that the number of staff members suffering from rough hands decreased. Also, we are pleased that minimizing product use has resulted in reduced administrative space and costs by reducing the number of items handled. Lastly, we experienced a pleasant sensation on the hands when the product is used.

In February of 2018, I saw the TUD-1000 displayed in the Saraya booth at the conference of the Japanese Society of Infection Prevention and Control. At that time, we were using a foot-operated dispenser and had considered changing to an automatic dispenser. But the device we considered at that time required frequent battery changes, and we could not determine which department would be in charge of changing the batteries. So we did not end up adopting the device. However, when we found out that the TUD-1000 batteries last from six months to a year and do not need to be changed frequently, we decided to test them.

- What were the deciding factors in installing the TUD-1000?

Many staff members who have test-used the TUD-1000 have positive feedback due to its ease of use. Depending on the performance of the dispenser, some dispensers require the user to hold their hand just above the sensor to dispense the disinfectant, which may cause contamination if the user's hand touches the nozzle. The TUD-1000, however, is highly sensitive and sprays disinfectant from an appropriate distance, so the risk of contaminating the nozzle with the user’s hand is low and hygienic.

In addition, the spray volume can be adjusted in advance to 3mL, 5mL, or 20mL for continuous spraying, so the appropriate amount can be sprayed in one try without repeatedly holding the hand over it. At our hospital, we use the 3mL setting for the spray volume. We also appreciate the fact that a dedicated tubing unit is included with each bottle of disinfectant, so a new, clean tube can be used each time the chemical solution is changed.

To introduce the new dispenser, we held an ICT meeting and an Operating Room Steering Committee meeting. At the Operating Room Steering Committee meeting, we demonstrated the rubbing method using the actual dispenser in front of physicians. The committee meeting was able to obtain the approval of all committee attendees, leading to the official use of the TUD-1000 in April 2018.

After installation

- How has the TUD-1000 been received after its installation?

So far it has been running smoothly with no problems. The operating room nurses are in charge of changing the batteries, but in the five months since the system was introduced, it hasn’t been necessary to change the batteries even once.

The foot-operated dispenser we used before had problems with the cord getting tangled and the disinfectant clogging up and not coming out, but these are no longer problems since we replaced it with the TUD-1000.

We want not only nurses but also doctors to actively adopt the rubbing method for hand disinfection before surgery, and we have posted the rubbing method procedure panel above the TUD-1000 (Photos 1 and 2). This seems to have been effective, and since the introduction of the TUD-1000, the number of physicians performing the rubbing method has been increasing, especially among residents and other young doctors. They practice disinfection using the rubbing method by imitating the nurses' procedures and asking questions to the nurses (Photo 3).

Photo 1: TUD-1000 installed in the operating room	Photo 2: Procedure panel for rubbing method posted on TUD-1000	Photo 3: Using the TUD-1000 while viewing the procedure panel

NEXT STEP

- What are your future challenges and goals?

When introducing the TUD-1000 to the Operating Room Steering Committee, we demonstrated the rubbing method using the device and were able to promote the rubbing method to physicians. We hope to gradually get all physicians interested in the rubbing method and eventually unify the method of hand disinfection before surgery for all staff members. (Ms. Hamatani, chief nurse)

Pharmacists are not on the front lines of the field like nurses. I would like to gather information to provide easy-to-use devices and create an environment where nurses and other front-line staff members can work comfortably. (Mr. Sato, pharmacist)

We would like to continue to introduce more and more products that are easy for our staff to use, such as the Hibiscohol A1%, and establish a system that will serve as a model for other hospitals. In addition, there are still some staff members in our hospital who suffer from rough hands. I would like to eliminate the situation where our staff suffer from rough hands (Mr. Sugiura, certified infection control nurse).

(From the left, Mr. Sugiura, Certified Infection Control Nurse/ Ms. Hamatani, Chief Nurse/ Mr. Sato, Pharmacist)