Background: An important cause of nonoptimal hand hygiene may be lack of "user friendliness" of hand hygiene resources due to violation of ergonomic principles in the design of the hospital environment and lack of timely replenishment of consumable resources. Methods: An ergonomics-based tool, SWAG (for the four main hand hygiene resources - sinks, waste receptacles, alcohol-based hand rub dispensers, and gloves) was developed and implemented to assess the intensive care units and 59 individual rooms in the hospital for structural ergonomic characteristics that facilitate usage of these resources. Results: Several deficiencies in the structural layout of hand hygiene resources were identified that hinder their usage, such as poor visibility, difficulty of access, placement at undesirable height, lack of redundancy, and wide spatial separation of resources that are used sequentially. Consumable hand hygiene resources were often not available because of lack of timely replenishment. Discussion: Many simple inexpensive changes using ergonomic principles can be implemented to promote hand hygiene in hospitals.
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