Electronic Monitoring of Hand Hygiene: Challenges and Methods

Friday, 25 July 2014

Elaine Larson, RN, BSN, MA, PhD1
Bevin Cohen, BA, MPH2
Meghan Murray, BA, MPH1
Paul Alper, BA3
Lisa Saiman, BA, MPH, MD4
Laurie Conway, BSN, MSN1
(1)Columbia University School of Nursing, New York, NY
(2)Center for Interdisciplinary Research to Prevent Infections, Columbia University School of Nursing, New York, NY
(3)DebMed USA, Charlotte, NC
(4)Pediatric Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY


Because hand hygiene (HH) is one of the primary strategies to prevent infection transmission, many facilities are now monitoring staff HH behavior using direct observation.  Observation, however, is costly and subject to multiple biases.  Therefore, electronic monitoring of HH has been proposed as a feasible and potentially more accurate solution for tracking trends in HH practices and for providing staff with performance feedback.  The purpose of this presentation is to discuss implementation of an electronic HH monitoring system, including challenges and strategies.


An electronic group monitoring system which counted number of HH events, but had no individual identifiers, was installed in all soap and alcohol dispensers in patient care areas of three pediatric long term care facilities (284 beds) and one acute care community hospital (140 beds) located in the United States. The system generates graphs and reports using various formats (locations, times).  Researchers worked with administrative staff in each facility to develop implementation plans, determine how feedback would be provided to patient care staff, and track changes in HH rates.  Reports were generated and sent to individuals selected by each facility.  Report formats could also be changed by these individuals at each facility.


Challenges during implementation of the system included addressing staff/administrator concerns about the validity and use of data, ensuring that feedback on HH reached patient care staff, and dealing with wide variations in implementation across sites. Administrators were inconsistent in disseminating the information; several months after installation, many staff members in some facilities were still unaware of the monitoring strategy and had received no feedback.

In the community hospital, when compared to HH frequency before staff feedback, frequency of HH for medical-surgical units, coronary care unit, and emergency department was slightly, but statistically significantly higher, after providing staff feedback (mean difference=4.9% compliance, SD 4.3, p=0.02). In the pediatric long term care facilities, however, HH frequency 3 month prior to and 3 months following staff receipt of electronic HH feedback was not significantly changed (21,730 and 20,910 HH episodes, respectively).


Monitoring HH is performed in many facilities, but feedback alone is not sufficient to improve practice.  Even with automated monitoring systems, well planned implementation strategies are essential to improve HH practice.