Background: There is increasing interest in automated monitoring of hand hygiene, but these systems are expensive. Current published estimates for electronic compliance monitoring (ECMS) range from $350–2,600 USD per bed. Additional and sometimes unexpected costs are as equally important to consider. Unfortunately, it is not always easy to foresee or calculate those ‘hidden’ costs. Methods and materials: An academic, 865-bed urban medical center implemented a wireless hand hygiene ECMS. The beacons, dispensers, batteries, badges, installation, technical support, marketing materials, and vendor-led training sessions were included in the contract for implementation of this technology. We calculated estimated financial costs not included in the contract, using the hourly rate of the employee required to perform the task and the cost of supplies. Results:Tabled 1Additional CostsCost (USD$)Hours/AmountTotalFull time program coordinator$40,000/y1$40,000Moving dispensers (patching walls – supplies & labor)$40/dispenser100$4,000Physician team leader's time$70/h (variable)24$1,680Infection control team leader's time$40/h (variable)12$480Lost badge replacement/Additional badges$40/badgevariablevariableSupport services (IT/HR/Legal/Regulatory)$40/h40–100$1,600–4,000Total Additional Costs:$45,000–$60,000/y Open table in a new tab Conclusion: The internal personnel required to implement and manage the project drove most additional costs. A planning and implementation team is necessary to guide the project and assist with important communication to departments, units, and hospital leadership. A full-time project coordinator is critical to administer the program and fully implement the technology across all provider types. The project coordinator also provided the data analysis and end user feedback necessary in order for the technology to be impactful on the organization's hand hygiene practice. Smaller organizations may have fewer unanticipated costs compared to larger centers; nevertheless, unexpected costs may also be more difficult for smaller organizations to absorb. When considering implementation of an ECMS, the cost of the technology itself is one of the major deciding factors. However, there may be significant ‘hidden’ costs related to a successful deployment of an ECMS which should be considered.