Fire group allows alcohol rubs in hospital hallways

CMS still needs to adopt code change

Hand hygiene may get a boost from more widespread use of alcohol-based hand rubs, as the National Fire Protection Association (NFPA) voted to permit dispensers in corridors of hospitals.

Responding to concerns about the dangers of hospital infections, the NFPA amended its 2000 and 2003 Life Safety Code to allow the convenient use of dispensers and set criteria for their installation.

There is a caveat: Local or state fire marshals may still restrict the hand rubs, and hospitals must follow the strictest regulatory authority. And though the Centers for Medicare & Medicaid Services (CMS) views the NFPA votes as a positive move, the agency may need to go through rulemaking before it is CMS-sanctioned.

"Right now, the policy is if you don’t have them in the corridor, don’t put them in yet," says a CMS official. "If you already have them in an exit access corridor, ask for a temporary waiver from CMS and say the action is pending resolution."

The Joint Commission on Accreditation of Healthcare Organizations has no problem with the hand-rub dispensers. In fact, it strongly supports their use to reduce hospital infections, a national patient safety goal of the organization.

"We will allow the installation of the dispensers and the storage of any replenishment supplies, per the Temporary Interim Agreement that has been approved by the NFPA Standards Council," says Dean Samet, CHSP, CJCS, associate director of accreditation operations and the Joint Commission’s senior engineer.

"As long as the requirements they have listed out in there are followed, I don’t see any problem with it," he adds.

Alcohol-based hand rubs have been touted as a way to reduce the 2 million hospital infections per year. When the Centers for Disease Control and Prevention (CDC) issued its updated hand hygiene guidelines in 2002, the main question was how to change health care worker habits.

But fire officials questioned the placement of flammable material in a hallway. In the case of a fire, the alcohol-based gels could be an accelerant. The hand rubs have been allowed in patient rooms or suites.

Infections outweighed fire risk

But convenience is an important issue for health care workers. Studies show increasing the availability of alcohol-based hand rubs can make health care workers more compliant with hand hygiene, says Loretta Litz Fauerbach, MS, CIC, director of infection control at Shands Hospital at the University of Florida in Gainesville.

She recommends providing dispensers in the patient rooms as well as outside in the hallway. Pocket-sized containers provide a backup if dispensers are not nearby.

"As one physician described to me, it is very easy to hit the dispenser as you walk in the door and decontaminate your hands by rubbing them together with the alcohol rub as you approach the patient," Fauerbach points out. "Your hands are clean, and the patient also sees that you have done that."

Visibility and convenience were important issues as the American Society for Healthcare Engineering (ASHE) of the American Hospital Association pushed for the NFPA change.

"Now we can put them where people will see them and, therefore, be more likely to use them," notes Susan McLaughlin, MBA, CHSP, MT(ASCP)SC, president of SBM Consulting in Barrington, IL, and a codes and standards consultant to ASHE.

ASHE conducted a study that showed no significant additional fire risk from having dispensers at or near the entrance to patient rooms. That was a significant factor in the NFPA approval, explains McLaughlin.

ASHE now is seeking a similar change in the International Fire Code from the International Code Council. The NFPA Temporary Interim Amendment will need to be incorporated in the 2006 Life Safety Code.

The NFPA now allows the dispensers in corridors with these conditions:

• The corridor width must be 6 feet or greater and dispensers must be separated at least 4 feet apart.

• The maximum individual dispenser fluid capacity is 1.2 liters for dispensers in rooms, corridors, and areas open to corridors, and 2 liters for dispensers in suites of rooms.

• The dispensers may not be installed over or directly adjacent to electrical outlets and switches.

• In locations with carpeted floor coverings, dispensers installed directly over carpeted surfaces are permitted only in sprinklered smoke compartments. Each smoke compartment may contain a maximum aggregate of 10 gallons of alcohol-based hand-rub solution in dispensers and a maximum of 5 gallons in storage.

Despite some initial reservations, CMS supported the change. However, when the NFPA retroactively amended its 2000 Life Safety Code, it created a technical difficulty for CMS. The change can’t automatically become part of CMS regulation, says a CMS official.

"The NFPA code is written by a private organization," he says. "In order to adopt it as a federal agency, we have to go through rulemaking."