Should automated electronic hand-hygiene monitoring systems be implemented in routine patient care? Systematic review and appraisal with Medical Research Council Framework for Complex Interventions

Abstract

Manual hand hygiene audit is time-consuming, labour-intensive and inaccurate. Automated hand hygiene monitoring systems (AHHMSs) offer advantages (generation of standardised data, avoidance of the Hawthorne effect). World Health Organization Guidelines for Hand Hygiene published in 2009 suggest that AHHMSs are a possible alternative. Assess the current state of the literature for AHHMSs and offer recommendations for use in real world settings. Systematic literature review. Publications included from the time that PubMed commenced until 19.11.2023. Forty-three publications met the criteria. Using the Medical Research Council's Framework for Developing and Evaluating Complex Interventions, two were categorised as intervention development studies. Thirty-nine were evaluations. Two described implementation in real world settings. Most were small scale and short duration. AHHMSs in conjunction with additional intervention (visual or auditory cue, performance feedback) could increase hand hygiene compliance short-term. Impact on infection rates was difficult to determine. In the few publications where costs and resources were considered, time devoted to improving hand hygiene compliance increased when an AHHMSs was in use. Health workers' opinions about AHHMSs were mixed. At present, too little is known about the longer-term advantages of AHHMSs to recommend uptake in routine patient care. Until more longer-term accounts of implementation (over 12 months) become available, efforts should be made to improve direct observation of hand hygiene compliance to improve its accuracy and credibility. The MRC Framework could be used to categorise other complex interventions involving use of technology to prevent infection to help establish readiness for implementation.