Electronic Hand Hygiene Research Articles

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.

Pitfalls of a Staged Implementation of an Automated Hand Hygiene System: Lessons Learned

Background: Hand hygiene is the first defense against healthcare-associated infections, yet studies show that adherence to hand hygiene still remains low. An academic medical center selected a beacon-based automated hand hygiene reminder system to improve hand hygiene adherence. Accountability is challenging to enforce without a reliable means to measure hand hygiene adherence. The hospital used secret shoppers to observe hand hygiene adherence. This method captures an estimated 0.5%–1.7% of opportunities and may be influenced by the Hawthorne effect. Methods: In November 2018, a phased trial of an electronic hand hygiene reminder system began in 4 intensive care units (ICUs). The system selected used a badge and beacon technology. The badge identifies each care provider and displays colored lights to show adherence status. Beacons are present on the patient’s bed, soap, and hand sanitizer dispenser. These beacons establish a “patient zone” that captures opportunities for hand hygiene. The specialty beds in the ICUs were supposed to remain on the units. A patient transferring to a lower level of care would be placed on another bed or gurney when leaving the ICU. ICU staff were badged for the system. Results: The phased implementation strategy had challenges with beds, badges, and the system. Despite planning, education, and communication, the beds left the ICU area, so the beaconed beds were outside the ICU, and staff did not always wear their assigned badge. There were issues with the system router as well. Unit leadership and the infection control team worked on processes to get beds back into the units. The implementation team decided to provide badges to staff who regularly worked in the ICU to differentiate from consultation groups that came to the ICU (and were not badged). The system routers were plugged in at various places on the units and had become unplugged so information was not sent for reports. Despite these issues, over the year of implementation, the units did achieve an increase in hand hygiene adherence from 48% to 85%. Collectively, the units achieved a 53% reduction in central-line–associated blood stream infection (CLABSI), reducing infections from 13 to 7 and a 35% reduction in methicillin-resistant Staphylococcus aureus (MRSA), reducing infections from 8 to 3 as defined by the NHSN. Conclusions: When implementing a beacon-based, automated hand hygiene system, staged implementation can be challenging. To avoid these challenges, facility-wide implementation is preferable.Funding: NoneDisclosures: None

A Decade in Trying to Increase Hand Hygiene—Finally Success

Background: Over the past 10 years, a rural health system has tried 10 different interventions to reduce hospital-associated infections (HAIs), and only 1 intervention has led to a reduction in HAIs. Reducing HAIs is a goal of nearly all hospitals, and improper hand hygiene is widely accepted as the main cause of HAIs. Even so, improving hand hygiene compliance is a challenge. Methods: Our facility implemented a two-phase longitudinal study to utilize an electronic hand hygiene reminder system to reduce HAIs. In the first phase, we implemented an intervention in 2 high-risk clinical units. The second phase of the study consisted of expanding the system to 3 additional clinical areas that had a lower incidence of HAIs. The hand hygiene baseline was established at 45% for these units prior to the voice reminder being turned on. Results: The system gathered baseline data prior to being turned on, and our average hand hygiene compliance rate was 49%. Once the voice reminder was turned on, hand hygiene improved nearly 35% within 6 months. During the first phase, there was a statistically significant 62% reduction in the average number of HAIs (catheter associated urinary tract infections (CAUTI), central-line–acquired bloodstream infections (CLABSIs), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant organisms (MDROs), and Clostridiodes difficile experienced in the preliminary units, comparing 12 months prior to 12 months after turning on the voice reminder. In the second phase, hand hygiene compliance increased to >65% in the following 6 months. During the second phase, all HAIs fell by a statistically significant 60%. This was determined by comparing the HAI rates 6 months prior to the voice reminder being turned on to 6 months after the voice reminder was turned on. Conclusions: The HAI data from both phases were aggregated, and there was a statistically significant reduction in MDROs by 90%, CAUTIs by 60%, and C. difficile by 64%. This resulted in annual savings >$1 million in direct costs of nonreimbursed HAIs.Funding: NoneDisclosures: None

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 (<20 beds) rural facilities to large (>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 >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.

Multi-Facility Reduction in Hospital-Acquired Infections (HAIs) Through Real-Time Feedback and Individual Accountability

Background: Hospital-acquired infections (HAIs) are a leading cause of healthcare morbidity and cost for the health community. It is widely recognized that hand hygiene is the leading contributor infections, but hand hygiene still remains a major problem for nearly all healthcare systems. A longitudinal study was conducted over a 4-year period in a community-based health system. Methods: An electronic hand hygiene reminder system was installed in 2 different facilities including both critical care and noncritical units. This system collects data on individual healthcare provider hand hygiene and provides a real-time voice reminder in the event that a provider forgets to perform hand hygiene. The primary study was designed to investigate the impact of a real-time voice reminder to improve hand hygiene. A baseline period of hand hygiene was established prior to the interventions after installing the system without any access to data reporting or the voice reminder. Each of the hospitals had the voice reminder turned on and off 3 times. The baseline HAI rates were established by comparing in each facility for the 12 months prior to the implementation of the system. During the study period, there were no significant changes to other common infection control practices. Results: In both facilities, every time the voices were turned on, hand hygiene improved significantly and each clinical unit saw a >200% improvement in hand hygiene within 3 months of turning the voice reminder. HAIs fell by a statistically significant in all clinical areas by 51%. After a period of stabilization, the voice reminder was turned off hand hygiene compliance fell and HAI rates then increased. The voice reminder was then turned back on and off 2 more times. In every case, hand hygiene rates fell back to the baseline and HAIs returned to their baseline. When the voice reminder was then turned back on, HAIs dropped to 54%–81% of the baseline in each of the clinical units. The system also captured individual providers’ hand hygiene performance data and displayed it in a simple and engaging way, allowing managers easily understand who was struggling with hand hygiene. These data were then leveraged through a series of competitions to systematically drive hand hygiene performance improvement. These included traditional interventions to address an education issue in addition to interventions to identify workflow problems. Conclusions: Using this highly targeted approach, the leadership were able to efficiently drive sustained hand hygiene improvement and a further reduction in HAIs.Funding: NoneDisclosures: None

Implementation of a Hospital-wide Electronic Hand Hygiene Monitoring Program Reduces Healthcare-acquired Infections in a Level I Trauma Hospital

<h3>Background</h3> Despite evidence that increased hand hygiene compliance (HHC) has been attributed to reduction in healthcare-acquired infections (HAIs), HHC in healthcare is 40% today. Non-adherence varies by discipline (job roles). An electronic hand hygiene compliance monitoring system (eHHCMS) measuring compliance at the bedside has been shown to improve and sustain HHC between 85-95%. <h3>Methods</h3> An urban, 353-bed Level I trauma hospital monitored HHC from April 2018-April 2019 using a direct observation model whereby selected staff performed observations of their peers' HHC. eHHCMS was installed and HHC monitored from May 2019-October 2019. The standardized infection ratio (SIR) for HAIs were measured using National Healthcare Safety Network analysis tools throughout the pre and post-implementation period. Costs of HAI were calculated using peer-reviewed literature and hospital-specific data. <h3>Results</h3> Hospital-wide HHC using the direct observation method was documented as 91% with 6362 observations annually. However, at baseline the eHHCMS documented HHC at 61.5%. After training and implementation, hospital-wide HHC was sustained at 88% with 2,399,020 recorded events. HHC varied across job roles, ranging from 72-92%; nursing (88%), nursing assistants (76%) and notably, providers (multiple specialties) had the highest HHC at 92%. The hospital-wide CAUTI, CLABSI and CDI ratios decreased by 17.7%, 36.2% and 16.5% respectively in the post-implementation period. <h3>Conclusions</h3> eHHCMS is improving and sustaining HHC 43.1% over baseline with less subjectivity and markedly increased observation opportunities. The ability to measure compliance by job role is helping focus improvement efforts. HAI SIRs and associated cost is decreasing significantly after implementation of eHHCMS. Even considering the impact of other concurrent infection prevention interventions, HHC remains paramount in reducing our HAIs.

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.

Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections.

Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections. This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center. The preintervention period was January 2015 through June 2016. Baseline electronic hand hygiene data collection took place from April through June 2016. The intervention period was July 2016 through December 2017. An electronic hand hygiene system was installed in 4 locations in our hospital. Performance improvement strategies were implemented that included education, troubleshooting, data dissemination, and feedback. Adherence rates were tracked over time. Rates of hospital-acquired infections were evaluated in the intervention units and in control units selected for comparison. The intervention period was subdivided into the initial and subsequent 9-month periods and were compared to the baseline period. Electronically measured hand hygiene rates improved significantly from baseline to intervention, from 47% 77% adherence. Rates >70% continued to be measured 18 months after the intervention. Interrupted time series analysis indicated a significant effect of hand hygiene on healthcare facility-onset Clostridioides difficile infection rates during the first 9 months of the intervention. This trend continued during the final 9 months of the intervention but was nonsignificant. No effects were observed for other hospital-acquired infection rates. Implementation of electronic hand hygiene monitoring and performance improvement interventions resulted in reductions in hospital-onset Clostridioides difficile infection rates.

Electronic hand hygiene monitoring: accuracy, impact on the Hawthorne effect and efficiency.

Objectives:To evaluate a type five electronic monitoring system (EMS) for hand hygiene (HH) adherence with respect to accuracy and ability to avoid the Hawthorne effect.Design:HH events were observed manually and electronically. The agreement between the two observation methods was evaluated. Continuous electronic measurement was made throughout the study.Setting:An acute 31-bed medical ward in a National Health Service trust in London, United Kingdom.Participants:Staff working or attached to the ward.Intervention:A newly developed type five EMS that can measure disinfectant dispenser usage as well as continuous movements of health workers throughout the ward with arm-length precision and analyse HH adherence was installed at the ward.Results:A total of 294 HH events were observed in five sessions by an observer previously unknown to the ward. There was concordance between HH adherence assessed by manual observer and the EMS on 84% (79.1%–89.9%) of the occasions. During the five observation sessions, the observed HH adherence increased from 24% to 76% while the EMS measurements immediately before the arrival of the observer remained constant for all sessions.Conclusion:The 84% agreement between the EMS and the manual observation suggest a high level of precision for the evaluated system. The Hawthorne effect (higher rate of HH performance) was clearly seen in the increase by a factor of three in the manually observed adherence from session to session as the health workers became more aware of them being observed. The EMS was able to avoid the Hawthorne effect when the observer was not present.

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.

Out of sight, out of mind: a prospective observational study to estimate the duration of the Hawthorne effect on hand hygiene events

BackgroundHuman auditing has been the gold standard for evaluating hand hygiene (HH) compliance but is subject to the Hawthorne effect (HE), the change in subjects’ behaviour due to their awareness...

Frequency of hand hygiene opportunities in patients on a general surgery service

Some electronic hand hygiene (HH) monitoring systems require a benchmark of HH opportunities. To establish a benchmark, we measured rates of HH opportunities among general surgery patients at a tertiary care hospital. Trained observers recorded HH opportunities for newly admitted patients daily for up to 5 days. We used multivariable logistic regression to assess the relationship between patient variables and the HH opportunity rate. A subset of observed HH events was compared to event data from an electronic HH monitoring system. We observed 2,404 HH opportunities over 677.4 care-hours for 23 patients (median 3.25 per hour; IQR 2.2-4.7, range 0-13). Rates of HH opportunities were significantly higher on admission day 1, for sessions starting before 9 AM, and for patients without roommates. HH was performed using alcohol-based hand rub from dispensers at the door to a patient's room more often than bedside or pocket dispensers (72.7% vs 20.8% or 5.1%). Electronic dispenser event counts did not match observed event counts. Our results provide a benchmark HH opportunity rate for general surgery patients, and highlight the importance of validating electronic HH event counts. Further research is needed to determine which patient factors affect HH opportunity rates.

1186. Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital

BackgroundHand hygiene (HH) is the cornerstone of infection prevention and improved compliance has been associated with reduced healthcare-associated infections (HAIs). However, traditional methods for HH data collection have limitations and may not accurately reflect true compliance. We sought to evaluate whether an electronic hand hygiene monitoring system (HHMS) can improve data collection, compliance, and reduce HAIs.MethodsA HHMS was implemented as part of a pilot at a single facility in June 2018 for all healthcare workers (HCWs) who entered patient rooms. The system prompted HCWs to perform HH with an audible and visual reminder emitted from a badge if a HH event had not been registered within specific timeframes of entering or exiting a patient room. The system captured compliance with preferential handwashing (soap and water) for at least 15 seconds upon exit of Clostridioides difficile (C. difficile) designated rooms. All HH data were collected by the HHMS. Hand hygiene compliance and HAI data were compared for the pre-intervention (June 2017-May 2018) and intervention periods (July 2018-March 2019). No changes were made to environmental cleaning protocols or compliance monitoring, nor in antibiotic stewardship practices.ResultsHH compliance by direct observation in the pre-intervention period was 91% (1,612 observations). HH compliance with the HHMS during the intervention period was 97% (2,778,402 observations). The mean monthly HH opportunities recorded during the pre-intervention period was 134, while the HHMS captured 308,711, a greater than 2,300-fold increase. The incidence of healthcare facility-onset C. difficile infections (HO-CDI) pre-intervention was 9.60 per 10,000 patient-days (41 GDH+/Toxin+ laboratory-identified [labID] events/42,726 patient-days). With the HHMS, HO-CDI decreased 70% (P = 0.0003) to 2.89 per 10,000 patient-days (9 labID events/31,169 patient-days). No policy changes in environmental cleaning of high-touch surfaces were made or observed during the pilot.ConclusionThe use of an HHMS facilitated more comprehensive HH data and improved compliance. The preliminary findings also support an association between more robust HH compliance data and a significant decrease in toxin-producing CDI.Disclosures All authors: No reported disclosures.

Challenges encountered and lessons learned during a trial of an electronic hand hygiene monitoring system

Automated hand hygiene monitoring systems (AHHMS) are being developed to supplement direct observations of hand hygiene (HH). We compared compliance rates generated by direct observations and by a badge-based AHHMS. Observations of HH compliance were conducted in a surgical intensive care unit (SICU) and a general medical ward (GMW) during a 7-month baseline period and a 13-week intervention period, when compliance was also estimated using an AHHMS. Compliance rates were analyzed using time-series analysis. During the entire pre- and postintervention period, univariate analysis of observations revealed significant improvement in overall HH compliance in the SICU (P = .001) and the GMW (P = .03), beginning before implementation of the AHHMS. Initiation of the AHHMS was associated with a transient drop in entry and exit compliance on both units. During the intervention period, observations suggested that compliance on entry and exit continued to increase in the SICU, but not in the GMW. Time series analysis of AHHMS data revealed that entry and exit compliance did not change significantly in the SICU but decreased significantly in the GMW (P = .001). The average accuracy of the AHHMS was 60%. Based on observations, HH compliance increased during the baseline period. Observations and the AHHMS yielded different trends in compliance. The AHHMS's accuracy of HH events and health care personnel location were suboptimal.

Pitfalls and Unexpected Benefits of an Electronic Hand Hygiene Monitoring System

No single strategy is more effective than proper hand hygiene (HH) in reducing the spread of nosocomial infections. Unfortunately, health care worker compliance with HH is imperfect. We sought to improve HH compliance using an electronic hand hygiene monitoring system (EHHMS) in 2 units to collect unbiased data and provide feedback. In this prospective, quasi-experimental study, the Hyginex EHHMS was installed in 2 units at Tufts Medical Center. Ninety-one bracelets were assigned, and electronic data were collected over 8 months. Human observations continued. We compared HH compliance as measured by human observation before, during, and after EHHMS implementation. Pre- and post-implementation surveys were distributed to staff. The number of electronically captured HH compliance observations was small due to infrequent bracelet use after month 2 of the intervention. HH compliance, as determined by human observation, increased by an average of 1.3 percentage points per month (P = .0005). Survey responses revealed negative attitudes about the EHHMS before and after its implementation. Despite poor EHHMS participation and negative attitudes toward its implementation, HH compliance, as measured by human observation, significantly improved. Hospitals considering implementing an EHHMS should look to refine the intervention to encourage health care worker participation.

Obstacles to the successful introduction of an electronic hand hygiene monitoring system, a cohort observational study

BackgroundHand hygiene (HH) compliance remains low in many intensive care units (ICU). Technology has been suggested to improve HH compliance.We describe the introduction of an electronic HH surveillance and intervention system into the general ICU of a tertiary care teaching hospital, the obstacles to success and reasons for the system’s ultimate failure and removal.MethodsThe system was based on radiofrequency transmitters in patient areas, on HH dispensers, and individual personal bracelets. The transmitters were connected to a central computer. The system was designed to detect entry and exit from patient areas and provide real time alerts of missed HH performance.A staff satisfaction questionnaire was administered followed by validation of system accuracy. Electronic data were compared to human observer data collected during defined observation periods.ResultsData from 41 questionnaires revealed low satisfaction rate (21/41, 51%). Low system accuracy (31/41, 76%) and inconvenience (18/41, 44%) being the most frequent reasons.During 44 one hour observation periods the observer recorded more HH opportunities and performances than the electronic system (mean number of HH opportunities/hour 10.9 ± 7.6 vs 6.8 ± 6.9, p < 0.001, correlation r = 0.75, p < 0.001, and performances/hour 8.7 ± 3.9 vs 6.0 ± 3.1, p < 0.001, correlation r = 0.60, p < 0.001, respectively). Correlation between observer and HH electronic system was very low (correlation coefficient r = 0.03, p = 0.91).ConclusionsThe electronic HH system was not accepted by ICU staff principally due to inaccuracy and inconvenience. Inaccuracies were verified by direct observations. In order for an electronic HH system to succeed we suggest it must be highly accurate and comfortable to use.

463. Healthcare Workers Perceptions Regarding the Use of an Electronic Hand Hygiene Monitoring System at a VA Hospital

BackgroundA cornerstone of healthcare-associated infection prevention is hand hygiene which has resulted in regulatory requirements to monitor hand hygiene compliance. Direct observation is the gold standard for hand hygiene compliance monitoring, but has several drawbacks. Electronic monitoring systems have begun to replace direct observation with several potential advantages, including larger sample size and more timely feedback. End user acceptance and adoption is a critical step to evidence-based practice implementation. To evaluate potential barriers and facilitators to adoption, we conducted a qualitative evaluation of nursing perceptions following a trial of an electronic hand hygiene compliance monitoring system.MethodsWe conducted four focus groups of 21 nursing staff on a medical/surgical inpatient unit at a tertiary care VA hospital. Nursing staff consisted of Registered Nurses, Nursing Assistants, and Health Technicians; of which there were 19 females and 2 males. Groups were audio recorded and tapes transcribed. Content analysis of transcriptions was undertaken to identify codes, categories, and themes.ResultsThemes identified as facilitators included: (1) unit champion; (2) electronic observation (vs. human observation); and (3) timely feedback. Themes identified as barriers included: (1) concern with data accuracy; (2) feasibility of frequent (daily) goal setting; and (3) staff knowledge of how system works.ConclusionNursing staff perceived electronic monitoring improved hand hygiene compliance. Staff verbalized negative perceptions with hand hygiene compliance monitoring but preferred electronic monitoring vs. human monitoring. Most barriers discussed revolved around the need to understanding how the electronic monitoring system works and need to believe the data are accurate. Implementation of this innovative technology will require extensive planning to address staff knowledge and understanding to ensure staff acceptance and adoption.Disclosures All authors: No reported disclosures.

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.

EI-102 - Immediate Feedback Yields Immediate Impact: Results of an Individual-Based Electronic Hand Hygiene Compliance Monitoring System on Healthcare Worker Behavior

Background: Improvement of Hand Hygiene (HH) compliance is a common goal in healthcare, but sustained achievement of that goal has proven difficult. It is well accepted that improving hand hygiene compliance, and maintaining that improvement, requires ongoing measurement and direct feedback of results, but these “simple” steps are time and resource intensive. In this study, an electronic hand hygiene compliance monitoring system (eHHCMS) was used both to monitor behavior and to give immediate feedback to healthcare workers (HCWs) on their HH compliance performance.