Hand hygiene is one of the most important measures for preventing healthcare-associated infections.
Hospitals, clinics, nursing homes and other healthcare facilities invest in alcohol-based handrub, soap, handwashing facilities and dispensers to support healthcare workers, patients and visitors.
But there is an important practical question that deserves more attention:
Is having a hand hygiene product available enough — or does its location matter just as much?
A dispenser may be installed somewhere in a healthcare facility, but if it is too far away, difficult to reach, poorly positioned or unavailable when needed, its practical value can be significantly reduced.
This is where the concept of Point-of-Care accessibility becomes important.
What Does “Point of Care” Mean?
In healthcare, the point of care is essentially the place where the patient, healthcare worker and care or treatment come together.
It may be:
- A patient’s bedside
- An examination room
- A treatment area
- An intensive care unit
- An emergency department
- A nursing station
- Another location where direct patient care takes place
For hand hygiene, the principle is relatively simple:
Hand hygiene products should be available as close as possible to where care is taking place.
WHO’s hand hygiene guidance emphasizes the importance of having hand hygiene products readily accessible at the point of care, so that healthcare workers can perform hand hygiene without unnecessary movement away from the patient zone.
The goal is not simply to have sanitizer somewhere in the building.
The goal is to make hand hygiene possible at the moment it is needed.
Available Does Not Always Mean Accessible
This distinction may sound simple, but it can have a significant practical impact.
Imagine a hospital where alcohol-based handrub is available on every floor.
From a facility-management perspective, hand hygiene products are clearly available.
But what happens if a healthcare worker needs to walk to another part of the room or corridor to access the nearest dispenser?
The product is available.
But is it truly accessible at the point of care?
This is an important difference.
Hand hygiene opportunities can occur quickly during patient care. If accessing a hand hygiene product requires unnecessary movement, interrupts workflow, or is inconvenient, the opportunity to perform hand hygiene may be affected.
This is why the question should not simply be:
“Do we have enough dispensers?”
It should also be:
“Are they located where hand hygiene actually needs to happen?”
A Global Challenge: Making Hand Hygiene Accessible
Access to hand hygiene is a challenge across healthcare systems worldwide.
The availability of alcohol-based handrub, soap, water and other hand hygiene supplies can vary significantly between countries, regions and individual healthcare facilities.
In some hospitals, hand hygiene products may be readily available at the bedside or treatment area.
In other settings, healthcare workers may need to move away from the point of care to access a dispenser or handwashing facility.
Even within the same healthcare system, accessibility can vary between departments and types of healthcare facilities.
WHO continues to emphasize that adequate infrastructure and uninterrupted access to hand hygiene supplies are important components of infection prevention.
This means that improving hand hygiene is not only a question of education and individual behavior.
It is also a question of healthcare environment design.
A Look at Europe
Europe provides one useful example of this challenge.
According to the OECD’s Health at a Glance: Europe 2024, based on 2022–23 data, an average of 55.6% of hospital beds in the EU had alcohol-based handrub dispensers at the point of care.
The figure varied considerably between countries.
The OECD also reported that greater availability of alcohol-based handrub dispensers was generally associated with lower prevalence of antimicrobial-resistant healthcare-associated infections at country level, while noting that the actual use of dispensers also matters.
This European data should not be interpreted as a global average.
Instead, it illustrates a broader issue that is relevant to healthcare facilities around the world:
Having hand hygiene products in a facility does not necessarily mean that they are available where healthcare workers need them most.
Why Placement Matters
The location of a hand hygiene dispenser may seem like a small facility-management detail.
In practice, it can influence how easily healthcare workers can incorporate hand hygiene into their normal workflow.
When evaluating a location, healthcare facilities may consider several practical questions.
1. Is it visible?
A dispenser should be easy to identify when hand hygiene is required.
2. Is it within easy reach?
Healthcare workers should be able to access hand hygiene products without unnecessary movement away from the patient or treatment area.
3. Does the location fit the workflow?
The best location is not necessarily the location with the most available wall space.
It should make sense within the actual movement and workflow of healthcare workers.
4. Is it accessible to the intended users?
Depending on the environment, accessibility may need to be considered for healthcare workers, patients, visitors or other users.
5. Can it remain available?
Placement also needs to be considered together with refilling, cleaning, inspection and maintenance.
A well-positioned dispenser is of limited value if it is empty or out of service.
Accessibility and Reliability Work Together
Accessibility is only one part of the equation.
A dispenser can be positioned perfectly at the patient’s bedside, but if it does not work when needed, it cannot effectively support hand hygiene.
This is why accessibility and reliability should be considered together.
An effective hand hygiene facility should ideally be:
Available → Accessible → Easy to use → Reliable → Properly maintained
If one element fails, the overall effectiveness of the facility can be affected.
For example:
- An accessible dispenser that is empty is not useful.
- A full dispenser that does not work is not useful.
- A reliable dispenser located too far away may not support point-of-care hand hygiene effectively.
- A sophisticated dispenser that is difficult to operate may create unnecessary barriers.
The objective is not necessarily to make every dispenser more technologically advanced.
The objective is to make hand hygiene easy, accessible and dependable.
Does Every Dispenser Need to Be “Smart”?
Healthcare technology is developing rapidly.
Connected dispensers, electronic monitoring, usage data and other digital technologies may provide valuable information for healthcare facilities.
These technologies can potentially help organizations understand usage patterns, monitor equipment status or support broader hand hygiene improvement programs.
But technology should serve a purpose.
A simple dispenser that consistently provides the right product at the right time may be more valuable than a highly sophisticated system that is difficult to maintain or unreliable in daily operation.
This leads to a simple principle:
A hand hygiene dispenser does not need to be smart just for the sake of being smart. It needs to work when people need it.
Technology can add value.
But reliability should remain fundamental.
From Equipment to Healthcare Environment Design
The discussion around hand hygiene is increasingly moving beyond the question of individual behavior.
Training and awareness remain essential.
But healthcare facilities can also influence behavior through the environment they create.
Consider the difference between:
“Please remember to perform hand hygiene.”
and:
“We have designed the environment so that hand hygiene is easy to perform.”
The second approach considers hand hygiene as part of the healthcare workflow.
This means thinking about:
- Where care takes place
- Where healthcare workers move
- Where hand hygiene opportunities occur
- Where products can be accessed most easily
- How equipment is maintained
- How reliably the system works
Small design decisions can therefore support larger infection prevention goals.
A Practical Checklist for Healthcare Facilities
When reviewing hand hygiene facilities, it may be useful to ask:
Availability
- Are sufficient hand hygiene products provided?
Accessibility
- Are they available at the point of care?
Placement
- Are dispensers positioned according to actual workflow?
Ease of use
- Can users operate them quickly and intuitively?
Reliability
- Do they consistently work when needed?
Maintenance
- Are they regularly refilled, cleaned and inspected?
Improvement
- Is usage or compliance monitored where appropriate?
These questions can help shift the focus from simply installing equipment to creating a hand hygiene environment that works in practice.
Conclusion
Hand hygiene may be a simple action, but supporting that action in a healthcare environment requires more than simply installing dispensers.
The global challenge is not only to make hand hygiene products available.
It is to make them:
Available where needed.
Accessible at the point of care.
Easy to use.
Reliable in daily operation.
And properly maintained.
Ultimately, the most useful question may not be:
“Do we have enough hand hygiene products?”
but:
“Can healthcare workers reach and use them easily at the moment they need them?”
Accessibility is therefore more than a facility-management issue.
It is part of creating an environment that supports infection prevention.
What is your experience?
For healthcare professionals, infection prevention specialists and facility managers:
What makes the biggest difference to hand hygiene in your facility — availability, accessibility, placement, reliability, ease of use, staff training, or monitoring?
We would be interested to hear your experience.