Electronic Hand Hygiene Monitoring Systems Research Articles

Healthcare Personnel Hand Hygiene Compliance: Are We There Yet?

Poor hand hygiene is well documented as a factor in healthcare-associated infections and excellent rates of hand hygiene remains elusive. There is increased use of universal or increased gloving to minimize hand contamination, but its use does not replace hand hygiene opportunities. There is significant interest in electronic hand hygiene monitoring systems, but they are not without their unique issues. Behavioral psychology remains a significant factor in motivating hand hygiene behaviors; even in COVID-19, hand hygiene rates initially improved but trended down back to baseline while still dealing with the pandemic. More emphasis should be placed on the how to properly perform hand hygiene and why it is so important, as well as the role of gloves, is needed. Continued investment and awareness of their status as role models from both system leadership and senior healthcare providers are needed.

Development and evaluation of an ultra-wide bandwidth based electronic hand hygiene monitoring system

BackgroundA large variety of electronic hand hygiene monitoring systems (EHHMS) are being developed and applied in health care settings. Monitoring hand hygiene (HH) opportunity at bed-level has been the key technical challenge. Accuracy evaluation needs more attention as the prerequisite upon widespread acceptance and adoption. MethodsFor the first time, we explored, debugged and upgraded an EHHMS based on ultra-wide bandwidth (UWB) which can obtain HH opportunities at bed-level. The real-time positioning and electronic fence of UWB technology was applied for EHHMS. The accuracy of EHHMS was compared with the simultaneous manual direct observations in real-world clinical setting. Sensitivity and specificity were calculated for EHHMS capturing HH action and opportunity. ResultsTwo generations of EHHMS were constructed. For the first generation, the system properly recorded 84% and 78% of the pre-identified HH actions and opportunities performed by experimenters. For the second generation, sensitivity and specificity of the system capturing HH action were 89% (84.83-92.36) and 100% (98.26-100.00), respectively. For capturing HH opportunity, the system showed the sensitivity and specificity of 86.52% (82.52-89.89) and 88.10% (84.14-91.36)), respectively. ConclusionThe EHHMS based on UWB could accurately identify HH action and opportunity with equivalent accuracy compared with simultaneous direct observation.

Electronic hand hygiene monitoring systems: Perceptions and behaviors

Background: Electronic hand hygiene monitoring systems (EHHMSs) are being increasingly utilized to improve hand hygiene outcomes. Following the implementation of an EHHMS at a large, academic medical center, an interdisciplinary team developed a web-based survey to gather information on employee’s perceptions and behaviors surrounding the EHHMS. Methods: In total, 1,273 complete responses were collected. Responses were analyzed using Stata version 16 statistical software with 2-tailed tests and .05 significance level. Multivariate logistic regression models were constructed to examine factors associated with negative perceptions of the EHHMS and of wearing the EHHMS radiofrequency identification (RFID) badge. Supporting qualitative analysis was performed using Atlas.ti version 9 software. Results: The general sentiment toward the monitoring system was neutral (38%) to negative (37%). The same was true for respondents’ sentiments toward wearing the RFID badge. Of respondents who interact with the system, 48% feel that the system does not capture hand hygiene data accurately. The EHHMS had limited influence on employee’s hand hygiene habits: 27% significant influence and 54% little-to-no influence. Respondents of younger age, those employed as a registered nurse, scientist, physician, or master’s level clinician, and those working at the satellite hospital were significantly more likely to have negative perceptions of the EHHMS. Negative perceptions were also significantly more likely among respondents familiar with the institution’s hand hygiene policy and those who had a negative opinion of seeing the hand hygiene data of others. Negative perceptions of the EHHMS RFID badge were significantly more likely among respondents of younger age, those employed as a registered nurse, scientist, physician, or master’s level clinician, those working at the satellite hospital, and those with a negative perception of seeing the hand hygiene data of others. Employment in a role providing direct patient care and those employed at the institution for >1 year were also significantly more likely to have a negative perception. Conclusions: Negative and neutral opinions dominate perceptions of the EHHMS considered in this analysis. Respondents expressed concerns with accuracy of the EHHMS data collection. The system’s limited influence is likely a result of limited familiarity, limited performance feedback, and employee frustration and concerns. These findings provide opportunities for improvement in future implementation of EHHMS. Based on these results, implementation of EHHMS would be best be supported by coordinated backing from administration and leadership, advanced planning and education, and frequent, effective communication. Additional research and evaluation are required to optimize implementation of electronic hand hygiene monitoring systems, with the goal of improving hand hygiene outcomes.Funding: NoneDisclosures: None

Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology.

BackgroundHand hygiene is one of the most effective ways of preventing health care–associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality.ObjectiveThis review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems.MethodsA systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author.ResultsIn total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7%), camera-assisted observation (10/73, 14%), sensor-assisted observation (29/73, 40%), and real-time locating system (32/73, 44%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33%).ConclusionsElectronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene–related issues.

Validation and implementation of group electronic hand hygiene monitoring across twenty-four critical care units.

An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units. Multicenter, observational study (10 hospitals)followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada. Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS. During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001). Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.

Electronic hand hygiene monitoring systems can be well-tolerated by health workers: Findings of a qualitative study.

Background:Electronic hand hygiene monitoring overcomes limitations associated with manual audit but acceptability to health workers varies and may depend on culture of the ward and the nature of the system.Objectives:Evaluate the acceptability of a new fifth type electronic monitoring system to frontline health workers in a National Health Service trust in the UK.Methods:Qualitative interviews with 11 informants following 12 months experience using an electronic monitoring system.Results:Informants recognised the importance of hand hygiene and embraced technology to improve adherence. Barriers to hand hygiene adherence included heavy workload, dealing with emergencies and ergonomic factors related to placement of alcohol dispensers. Opinions about the validity of the automated readings were conflicting. Some health workers thought they were accurate. Others reported problems associated with differences in the intelligence of the system and their own clinical decisions. Opinions about feedback were diverse. Some health workers thought the system increased personal accountability for hand hygiene. Others ignored feedback on suboptimal performance or ignored the data altogether. It was hard for health workers to understand why the system registered some instances of poor performance because feedback did not allow omissions in hand hygiene to be related to the context of care.Conclusion:Electronic monitoring can be very well tolerated despite some limitations. Further research needs to explore different reactions to feedback and how often clinical emergencies arise. Electronic and manual audit have complementary strengths.

A survey of commercially available electronic hand hygiene monitoring systems and their impact on reducing healthcare-associated infections

Although the benefits of electronic hand hygiene monitoring systems (EHHMSs) are well described, uptake has been poor since they were first introduced over 10 years ago. There is considerable published evidence on the association between the introduction of EHHMSs and improved hand hygiene (HH) compliance rates. However, their impact on healthcare-associated infection (HCAI) reduction is much less clear-cut. Commercial EHHMS identification was undertaken using a Google internet search and all relevant websites and marketing materials were reviewed. A structured literature search was undertaken to identify evidence of HCAI reduction through EHHMS implementation. Structured interviews were undertaken with a number of Directors of Infection Prevention and Control (DIPCs) from acute NHS Trusts in the North West of England to seek opinions on HH improvement strategies and the use of EHHMSs. Twenty-nine commercial EHHMSs were identified, 20 of which are currently market active. Six EHHMSs had supporting evidence, across nine published studies, demonstrating their ability to reduce HCAIs. However, most evaluation designs were quasi-experimental with only one study using a high-quality stepped-wedge cluster randomized controlled trial design. In this study the EHHMS was part of a wider HH multi-modal improvement strategy. Structured interviews were undertaken with five DIPCs who consistently expressed a reluctance to support financial investment into this type of technology until EHHMS cost-effectiveness was better established. The evidence base for the ability of EHHMSs to reduce HCAIs needs to improve before NHS trusts will consider procuring them.

Comparison of two electronic hand hygiene monitoring systems in promoting hand hygiene of healthcare workers in the intensive care unit

BackgroundHand hygiene (HH) is the cornerstone of infection control, and the promotion of HH is the focus of the world. The study aims to compare the role of two different types of electronic hand hygiene monitoring systems (EHHMSs) in promoting HH of healthcare workers (HCWs) in the intensive care unit (ICU).MethodsIn a 16-bed ICU of a general tertiary hospital in Shenzhen, the research was divided into three stages with interrupted time series (ITS) design. In the first stage, the direct observation method was used to monitor and feed back the HH compliance rate of HCWs monthly. In the second stage, the type1 EHHMS was applied to monitor and feed back the individual number of HH events monthly. In the third stage, the type2 EHHMS with a function of instant reminder and feedback was employed, and the personal HH compliance rates were fed back monthly. Meanwhile, direct observation continued in the last two stages.ResultsIn the second stage, The HH compliance rate increased. However, there was no significant difference in the trajectory of the rate compared with the first stage. In the first month of the third stage, the HH compliance rate increased by 12.324% immediately and then ascended by 1.242% over time. The number of HH events per bed day and HH products’ consumption per bed day were consistent with the change of HH compliance rate observed.ConclusionMonitoring and feedback can improve the HH of HCWs. The EHHMS, with the function of real-time reminders and feedback, has a more noticeable effect on promoting HH.

A standardised approach to validate both the accuracy and precision of electronic hand hygiene monitoring systems is needed.

A standardised approach to validate both the accuracy and precision of electronic hand hygiene monitoring systems is needed.

Large-Scale Analysis of Hand Hygiene Frequency Across Healthcare Facilities Varying in Key Hospital Characteristics

Background: Hand hygiene by healthcare personnel is a critical infection prevention intervention. Direct observation, the most widely utilized method to observe hand hygiene practices, often provides an incomplete picture due to small sample size and altered behavior in the presence of observers. A growing number of healthcare facilities are employing electronic hand hygiene monitoring systems to capture overall compliance rates. These electronic systems can provide a wealth of data on hand hygiene practices within and across healthcare facilities. Objective: We used high-accuracy electronic monitoring data to perform a detailed analysis of hand hygiene practices across numerous facilities that varied in key hospital characteristics. Methods: In total, 11 tertiary-care facilities were equipped with an electronic hand hygiene monitoring system. Hospitals varied in size, region, area classification (urban vs rural), acuity level, and teaching status. The electronic monitoring system was composed of uniquely assigned employee badges and electronically monitored dispensers. Every recorded dispensing event was time stamped and associated with a specific healthcare worker, the location of the dispenser, and the specific product being dispensed (ie, alcohol-based hand rub [ABHR] or hand soap). The total number of dispensing events for each product type and the total number of hours worked were calculated for each healthcare worker and were used to determine hand hygiene frequency. Hospital attributes, such as size and area classification, were obtained from publicly available sources including but not limited to facility-owned websites and CMS data. Results: More than 15.7 million hand hygiene events, performed by nearly 11,000 healthcare workers, were captured by the electronic monitoring system and were included in the analysis. Overall, median hand hygiene frequency was 4.1 events per hour and ranged from 2.0 events per hour to 5.6 events per hour, depending on the facility. ABHR use (median, 3.6 events per hour) was more frequent than handwashing (median, 0.4 events per hour). Hospitals included in the analysis ranged from small (&lt;20 beds) rural facilities to large (&gt;600 beds) academic hospitals and provided a variety of services from general medical-surgical treatment to intensive care. Interfacility differences in observed hand hygiene frequency were analyzed. Conclusions: The current analysis reinforces and builds upon previous work that examined a smaller subset of 5 hospitals located in a single geographic region. Combined, these datasets represent &gt;20 million hand hygiene events among ∼15,000 healthcare workers from 16 unique healthcare facilities. This analysis provides detailed information about hand hygiene practices across a diverse set of healthcare facilities.Funding: Ecolab, Inc, provided support for this study.Disclosures: Jessica Carol Albright and Cheryl A Littau report salary from Ecolab.

Adoption of Electronic Hand Hygiene Monitoring Systems in NYS Hospitals and the Impact on Hospital-Acquired C. Difficile Infection Rates

Background Despite rigorous infection control efforts, hospital-acquired infections (HAIs) remain a challenge for providers. Approximately 721,800 HAIs occur annually, generating an estimated $10 billion in costs. Proper hand hygiene (HH) is paramount for preventing HAIs, yet adherence with standard practices averages 50%. Electronic hand hygiene monitoring systems (EHHMS) are a potential solution, using sensor technology to track and signal HH events. Methods We explored adoption of EHHMS in New York State acute care hospitals through a survey and interviews. The impact of EHHMS on HAIs was also assessed by examining rates of hospital-acquired C. difficile infection (HA-CDI) pre- and post-implementation of this technology using trend analysis. Results Survey respondents represented approximately 30% (N = 56) of the total population of hospitals (N = 184) and EHHMS adoption was low (N = 2). Reasons for non-adoption were cost (79.6%) and concerns for accuracy in tracking HH events (28.6%). HH compliance increased 20-30% and HA-CDI decreased 70% for one hospital after EHHMS implementation, though this was not sustained. A robust HH culture was mentioned as a necessary accompaniment to electronic tracking. The second hospital declined to share their experience, and the trend analysis indicated no discernible impact on HA-CDI post-EHHMS implementation. A critical access hospital without an EHHMS reported HH compliance of 90%, which they attributed to strong HH culture. Conclusions Proliferation of EHHMS is low in NYS acute care hospitals and the impact of this technology on HH compliance and infection rates is so far questionable. With or without an EHHMS, a strong organizational culture in support of HH seems essential to achieving high compliance rates. Despite rigorous infection control efforts, hospital-acquired infections (HAIs) remain a challenge for providers. Approximately 721,800 HAIs occur annually, generating an estimated $10 billion in costs. Proper hand hygiene (HH) is paramount for preventing HAIs, yet adherence with standard practices averages 50%. Electronic hand hygiene monitoring systems (EHHMS) are a potential solution, using sensor technology to track and signal HH events. We explored adoption of EHHMS in New York State acute care hospitals through a survey and interviews. The impact of EHHMS on HAIs was also assessed by examining rates of hospital-acquired C. difficile infection (HA-CDI) pre- and post-implementation of this technology using trend analysis. Survey respondents represented approximately 30% (N = 56) of the total population of hospitals (N = 184) and EHHMS adoption was low (N = 2). Reasons for non-adoption were cost (79.6%) and concerns for accuracy in tracking HH events (28.6%). HH compliance increased 20-30% and HA-CDI decreased 70% for one hospital after EHHMS implementation, though this was not sustained. A robust HH culture was mentioned as a necessary accompaniment to electronic tracking. The second hospital declined to share their experience, and the trend analysis indicated no discernible impact on HA-CDI post-EHHMS implementation. A critical access hospital without an EHHMS reported HH compliance of 90%, which they attributed to strong HH culture. Proliferation of EHHMS is low in NYS acute care hospitals and the impact of this technology on HH compliance and infection rates is so far questionable. With or without an EHHMS, a strong organizational culture in support of HH seems essential to achieving high compliance rates.

Adoption of electronic hand hygiene monitoring systems in New York state hospitals and the associated impact on hospital-acquired C. difficile infection rates

Approximately 721,800 hospital acquired infections occur annually, generating an estimated $10 billion in provider costs. Proper hand hygiene (HH) prevents hospital acquired infections, yet compliance is low. Electronic hand hygiene monitoring systems (EHHMS) are a potential solution, tracking and signaling HH events. We explored adoption of EHHMS in New York State acute care hospitals through a survey and interviews. Trend analysis was used to evaluate the impact of EHHMS on hospital-acquired Clostridium difficile infection (HA-CDI) rates. Survey respondents represented approximately 30% (N = 56) of the total population of hospitals (N = 184) and EHHMS adoption was low (N = 2). The primary reason for nonadoption was cost (79.6%). HH compliance increased 20%-30% and HA-CDI decreased 70% for one hospital after an EHHMS, though not sustained; robust HH culture was mentioned as a necessary accompaniment. The trend analysis showed negligible impact on HA-CDI post-EHHMS for the second hospital. A critical access hospital without an EHHMS reported HH compliance of 90% attributed to strong HH culture. Proliferation of EHHMS is low in New York State acute care hospitals and its impact on HH compliance and infection rates is questionable. Putting technology aside, strong HH culture seems essential for high compliance.

461. Electronic Hand Hygiene Compliance Monitoring Systems: Not All Are Created Equal

BackgroundWhile direct observation is considered the gold standard for hand hygiene (HH) surveillance, there is a growing interest in the implementation of electronic monitoring systems, which claim to accurately capture individual-level HH performance.MethodsTwo types of electronic hand hygiene monitoring systems (EHHMS) were trialed at an 865-bed, academic medical center over an 18-month period. Each type of EHHMS was piloted in two inpatient units, and hospital employees who had contact with patients and/or the patient environment were eligible to participate. In each trial, participants received standard training and were then asked to wear EHHMS badges while continuing their normal workflow. Methods of assessment included regular review of EHHMS reports, an inter-rater reliability analysis to compare EHHMS to direct observation by trained HH observer, and a qualitative electronic survey to assess the acceptability of EHHMS. HH compliance goal was set at 90%.ResultsIn the first pilot, 279 employees volunteered to trial Type A EHHMS for 14 weeks, with an overall HH compliance of 30% (87,688 opportunities). In the second pilot, 169 employees volunteered to trial Type B EHHMS for 12 weeks, with an overall HH compliance of 93% (363,272 opportunities). Voluntary survey response rate for Type A was 32% (90/279) and for Type B was 40% (67/169). The majority of respondents consistently used EHHMS in daily workflow (Type A: 82%, 68/83) (Type B: 82%, 55/67) and most did not felt apprehensive about using the EHHMS (Type A: 19%, 16/83) (Type B: 22%, 15/67). Inter-rater reliability assessment of piloted EHHMSType of TechnologyUnitNumber of bedsTechnology ComplianceHH Observer ComplianceKappa StatisticTechnology AccuracyType AUnit 12015%(N = 86)90.8%(N = 308)0.03911%Unit 23042%(N = 98)89%(N = 470)0.18054%Type BUnit 33093%(N = 116)90%(N = 48)0.8197%Unit 43087%(N = 141)92%(N = 60)0.7495%ConclusionType B EHHMS captured our healthcare workers’ HH performance during clinical workflow with a greater accuracy and more HH events than Type A. EHHMS may provide an alternative method to capture HH compliance in the healthcare setting. Hospitals considering the use of an EHHMS should assess the technology’s ability to accurately capture HH performance in the clinical workflow prior full housewide implementation.Disclosures All authors: No reported disclosures.

Hand hygiene opportunities on Canadian acute-care inpatient units: A multicenter observational study.

In this multicenter observational study, medical and surgical inpatient rooms were randomized to receive 1 hour of continuous direct observation to determine hand hygiene opportunities (HHOs). After multivariable adjustment, HHOs were similar across inpatient units and hospitals. This estimate could serve to calibrate electronic hand hygiene monitoring systems for Canadian medical and surgical units.

Hand hygiene “hall monitors”: Leveraging the Hawthorne effect

Unfortunately, more than a decade after the World Health Organization's campaign launched, many centers still face challenges with low rates of hand hygiene compliance. Several electronic hand hygiene monitoring systems are available, and the cost of setup and maintenance varies by institution. At our institution, with extremely limited funds for complex interventions, we instead hired a pragmatic teenager in search of a summer job and trained her as a hand hygiene "hall monitor." We describe an effective, inexpensive intervention that improved our unit's hand hygiene performance while also providing youth employment.

Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals

Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff.

Challenges in implementing electronic hand hygiene monitoring systems.

Electronic hand hygiene (HH) monitoring systems offer the exciting prospect of a more precise, less biased measure of HH performance than direct observation. However, electronic systems are challenging to implement. Selecting a system that minimizes disruption to the physical infrastructure and to clinician workflow, and that fits with the organization's culture and budget, is challenging. Getting front-line workers' buy-in and addressing concerns about the accuracy of the system and how the data will be used are also difficult challenges. Finally, ensuring information from the system reaches front-line workers and is used by them to improve HH practice is a complex challenge. We describe these challenges in detail and suggests ways to overcome them.

A Review of Electronic Hand Hygiene Monitoring: Considerations for Hospital Management in Data Collection, Healthcare Worker Supervision, and Patient Perception

Healthcare-associated infections (HAIs) in U.S. acute care hospitals lead to a burden of $96-$147 billion annually on the U.S. health system and affect 1 in 20 hospital patients (Marchetti & Rossiter, 2013). Hospital managers are charged with reducing and eliminating HAIs to cut costs and improve patient outcomes. Healthcare worker (HCW) hand hygiene (HH) practice is the most effective means of preventing the spread of HAIs, but compliance is at or below 50% (McGuckin, Waterman, & Govednik, 2009). For managers to increase the frequency of HCW HH occurrences and improve the quality of HH performance, companies have introduced electronic technologies to assist managers in training, supervising, and gathering data in the patient care setting. Although these technologies offer valuable feedback regarding compliance, little is known in terms of capabilities in the clinical setting. Less is known about HCW or patient attitudes if the system allows feedback to be shared. Early-adopting managers have begun to examine their experiences with HH technologies and publish their findings. We review peer-reviewed research on infection prevention that focused on the capabilities of these electronic systems, as well as the related research on HCW and patient interactions with electronic HH systems. Research suggests that these systems are capable of collecting data, but the results are mixed regarding their impact on HH compliance, reducing HAIs, or both and their costs. Research also indicates that HCWs and patients may not regard the technology as positively as industry or healthcare managers may have intended. When considering the adoption of electronic HH monitoring systems, hospital administrators should proceed with caution.

Hand hygiene monitoring technology: protocol for a systematic review.

BackgroundHealthcare worker hand hygiene is thought to be one of the most important strategies to prevent healthcare-associated infections, but compliance is generally poor. Hand hygiene improvement interventions must include audits of compliance (almost always with feedback), which are most often done by direct observation - a method that is expensive, subjective, and prone to bias. New technologies, including electronic and video hand hygiene monitoring systems, have the potential to provide continuous and objective monitoring of hand hygiene, regular feedback, and for some systems, real-time reminders. We propose a systematic review of the evidence supporting the effectiveness of these systems. The primary objective is to determine whether hand hygiene monitoring systems yield sustainable improvements in hand hygiene compliance when compared to usual care.Methods/DesignMEDLINE, EMBASE, CINAHL, and other relevant databases will be searched for randomized control studies and quasi-experimental studies evaluating a video or electronic hand hygiene monitoring system. A standard data collection form will be used to abstract relevant information from included studies. Bias will be assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Assessment Tool. Studies will be reviewed independently by two reviewers, with disputes resolved by a third reviewer. The primary outcome is directly observed hand hygiene compliance. Secondary outcomes include healthcare-associated infection incidence and improvements in hand hygiene compliance as measured by alternative metrics. Results will be qualitatively summarized with comparisons made between study quality, the measured outcome, and study-specific factors that may be expected to affect outcome (for example, study duration, frequency of feedback, use of real-time reminders). Meta-analysis will be performed if there is more than one study of similar systems with comparable outcome definitions.DiscussionElectronic and video monitoring systems have the potential to improve hand hygiene compliance and prevent healthcare-associated infection, but are expensive, difficult to install and maintain, and may not be accepted by all healthcare workers. This review will assess the current evidence of effectiveness of these systems before their widespread adoption.Study registrationPROSPERO registration number: CRD42013004519

Implementing an Electronic Hand Hygiene Monitoring System: Meeting the Challenges

Hand hygiene (HH) compliance monitoring is resource-intensive and if not carefully conducted, can yield erroneous results. Electronic hand hygiene monitoring systems (EHHMS) are promising because they are less affected by biases inherent in self-reporting and direct observation, require fewer person-hours than observation, and are more precise than product usage measurement.