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Finally, CMS allows hand-gel dispensers in corridors

Ambulatory Safety Monitor, June 9, 2005

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Ending a lengthy debate over where to locate hand-gel dispensers, the Centers for Medicare & Medicaid Services (CMS) will now formally allow these dispensers in exit access corridors under certain conditions.

In a rule released March 25 in the Federal Register, the agency says the infection control benefits of staff using hand gels far outweighs possible fire risks.

"The relatively small quantity of gel in each dispenser, combined with the absence of vapor release, means that these dispensers, when properly installed and used, pose little fire risk in healthcare facilities," CMS says.

CMS published the provisions as a "interim final rule" that takes effect May 24. The interim rule approach allows CMS to release the regulation while still accepting public comments.

Though some aspects of the rule could change if a deluge of comments comes in, it's expected that the rule will remain as it was published.

I'll take those rules with a twist

In its new rule, CMS takes the well-known NFPA amendments to Chapters 18 and 19 in the Life Safety Code® (LSC) that permit gel dispensers in exit hallways and ratchets them up a bit.

CMS' new provisions include the following:

• Any use of gel dispensers can't conflict with state or local codes that prohibit or restrict the items-facilities must comply with stricter codes if there is a conflict, CMS says

• Facilities must ensure that dispensers don't leak, mainly to prevent someone such as a frail patient from slipping on a pool of gel on the floor; facilities should follow manufacturer instructions in this regard

• Facilities must install the dispensers in a way that protects them from abuse by "vulnerable populations," such as psychiatric patients-CMS worries that certain patients or residents may try to ingest gel or start a fire with it

Ambulatory centers get the nod, too

CMS' rule applies to hospitals and nursing homes, which the LSC amendment covers under Chapters 18 and 19 (healthcare occupancies).

It will also allow the dispensers in corridors of ambulatory surgical centers, which the LSC doesn't specifically permit at this point under Chapters 20 and 21 (ambulatory healthcare occupancies).

The Joint Commission on Accreditation of Healthcare Organizations already supports the LSC amendment.

Final rules for hand-gel dispensers

The Centers for Medicare & Medicaid Services will allow healthcare facilities to install hand-gel dispensers in exit corridors under the following conditions:

• The corridors must be at least 6 ft. wide

• You must separate the dispensers from each other by at least 4 ft.

• The maximum capacity for dispensers is 1.2 L (0.317 gal) for those in rooms, corridors, and areas open to corridors; that amount increases to 2 L (0.528 gal) for dispensers in suites

• You can't install dispensers over or directly adjacent to electrical outlets and switches

• If you want to install dispensers over carpeted floors, those floors must be in smoke compartments protected by sprinklers

• Each smoke compartment may contain a cumulative 37.85 L (10 gal) of hand gel solution in dispensers and a maximum of 18.92 L (5 gal) in storage

• The use of the dispensers can't conflict with more stringent state or local codes

• You must install the dispensers in a way that minimizes leaks and spills

• You must protect the dispensers against access by "vulnerable populations," such as psychiatric patients

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