In the JournalsPerspective

Electronic hand hygiene monitoring systems ‘vary substantially’

Michelle E. Doll, MD, MPH
Michelle E. Doll

Interest in monitoring hand hygiene compliance using automated technology has “increased substantially” in recent years, according to researchers, who found that not all electronic hand hygiene monitoring systems are created equal.

“While there is a lot of excitement around these automated systems from the infection prevention community and hospital leaders, the products vary substantially,” Michelle E. Doll, MD, MPH, assistant professor of medicine and associate hospital epidemiologist at Virginia Commonwealth University Medical Center, told Infectious Disease News. “Health care systems thinking of investing in this type of infection prevention must vigorously evaluate available products and consider whether or not the product will meet specific organizational goals.”

Doll and colleagues conducted 90-day trials in four distinct hospital units to compare two unnamed electronic hand hygiene monitoring systems (EHHMS) — identified as type A and type B. A hand hygiene observer team performed matched observations.

Both systems were completely automated and required prescribers to wear badges with embedded sensors. Hand hygiene events were captured by corresponding sensors on all soap and alcohol-based product dispensers, as well as in patient zones.

“Patient zones were defined by each system’s network to include areas around a patient’s bed, and semiprivate rooms were included with zones distinct for each patient,” Doll and colleagues wrote. “System settings expected the providers to perform [hand hygiene] on entry and exit to each patient zone.”

There was a notable difference between the systems — type B reminded providers to perform hand hygiene by beeping and displaying colored lights, whereas type A provided no immediate feedback.

For 14 weeks, 279 participants in unit 1 and unit 2 used the EHHMS type A for trial A.

The researchers observed an overall compliance rate of 30% in 87,688 hand hygiene opportunities. The implementation of this system was extended 2 weeks because “badge distribution required 2 weeks longer than anticipated.”

For 12 weeks, 169 participants in unit 3 and unit 4 used the EHHMS type B for trial B, and the researchers reported a 93% compliance rate in 363,272 hand hygiene opportunities.

According to the study, 6 months before each trial, the average hand hygiene observer data demonstrated an adherence rate of 86% in unit 1, 78% in unit 2, 92% in unit 3 and 91% in unit 4.

When assessing overall, observer-defined compliance rates, units using type A had a compliance rate of 90% compared with 91% for the type B units. Overall compliance for trial A, as determined by routine observer rounding, was 87%, whereas compliance for trial B was 92%.

“The hope is that by using technology to influence better hand hygiene practices, health care-associated infections would decrease. However, we do not yet have good evidence of clinical impact,” Doll said. “Because these technologies are relatively new, there are a lot of opportunities for further study; the ultimate goal would be to determine if the implementation of hand hygiene technologies can result in sustained decreases in health care-associated infections.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

Michelle E. Doll, MD, MPH
Michelle E. Doll

Interest in monitoring hand hygiene compliance using automated technology has “increased substantially” in recent years, according to researchers, who found that not all electronic hand hygiene monitoring systems are created equal.

“While there is a lot of excitement around these automated systems from the infection prevention community and hospital leaders, the products vary substantially,” Michelle E. Doll, MD, MPH, assistant professor of medicine and associate hospital epidemiologist at Virginia Commonwealth University Medical Center, told Infectious Disease News. “Health care systems thinking of investing in this type of infection prevention must vigorously evaluate available products and consider whether or not the product will meet specific organizational goals.”

Doll and colleagues conducted 90-day trials in four distinct hospital units to compare two unnamed electronic hand hygiene monitoring systems (EHHMS) — identified as type A and type B. A hand hygiene observer team performed matched observations.

Both systems were completely automated and required prescribers to wear badges with embedded sensors. Hand hygiene events were captured by corresponding sensors on all soap and alcohol-based product dispensers, as well as in patient zones.

“Patient zones were defined by each system’s network to include areas around a patient’s bed, and semiprivate rooms were included with zones distinct for each patient,” Doll and colleagues wrote. “System settings expected the providers to perform [hand hygiene] on entry and exit to each patient zone.”

There was a notable difference between the systems — type B reminded providers to perform hand hygiene by beeping and displaying colored lights, whereas type A provided no immediate feedback.

For 14 weeks, 279 participants in unit 1 and unit 2 used the EHHMS type A for trial A.

The researchers observed an overall compliance rate of 30% in 87,688 hand hygiene opportunities. The implementation of this system was extended 2 weeks because “badge distribution required 2 weeks longer than anticipated.”

For 12 weeks, 169 participants in unit 3 and unit 4 used the EHHMS type B for trial B, and the researchers reported a 93% compliance rate in 363,272 hand hygiene opportunities.

According to the study, 6 months before each trial, the average hand hygiene observer data demonstrated an adherence rate of 86% in unit 1, 78% in unit 2, 92% in unit 3 and 91% in unit 4.

When assessing overall, observer-defined compliance rates, units using type A had a compliance rate of 90% compared with 91% for the type B units. Overall compliance for trial A, as determined by routine observer rounding, was 87%, whereas compliance for trial B was 92%.

“The hope is that by using technology to influence better hand hygiene practices, health care-associated infections would decrease. However, we do not yet have good evidence of clinical impact,” Doll said. “Because these technologies are relatively new, there are a lot of opportunities for further study; the ultimate goal would be to determine if the implementation of hand hygiene technologies can result in sustained decreases in health care-associated infections.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Didier Pittet

    Didier Pittet

    The take-home messages are that we must be critical of EHHMS, making sure that the tools are both accurate and validated. We must recognize their current limitations; how moments observed by these systems actually relate to patient safety. Without an ability to measure all the WHO 5 moments [for hand hygiene], we cannot speak of compliance, but rather of hand hygiene events. EHHMS can have an important supplemental role in hand hygiene improvement strategies but cannot (yet) replace direct observation.

    • Didier Pittet, MD, MS, CBE
    • Director, Infection Control Programme and WHO Collaborating Centre on Patient Safety
      University of Geneva Hospitals and Faculty of Medicine

    Disclosures: Pittet reports no relevant financial disclosures.