Hand Hygiene Behaviors Monitored by an Electronic System in the Intensive Care Unit

Abstract

Background Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. Methods An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. Results A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Conclusions Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance. Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance.