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Electronic Monitoring Versus Direct Observation of Hand Hygiene Compliance in Healthcare Settings

November 15, 2018

Health Problem: Healthcare-associated infections (HAIs) are infections that patients acquire in a healthcare setting and are largely preventable, chiefly through adequate hand hygiene (HH). Compliance with HH guidelines can remain lax. Hospitals often assess HH compliance via direct observation (DO) by trained observers. DO has limitations in that it is costly and time consuming, requires training, measures only a small portion of HH opportunities, and has interrater variability issues.

Technology Description: Electronic HH monitoring systems monitor potential HH opportunities and/or events and vary in their degree of sophistication. The simplest are straightforward counters that record the number of times an antiseptic dispenser is used. More sophisticated systems have sensors that transmit signals from patient zones, sinks, antiseptic dispensers, doorways, etc. and can detect healthcare workers (HCWs) via wireless transmitters.

Controversy: Use of proxy measures of HH may not provide reliable indicators of HH compliance. In addition, uncertainty exists regarding the current accuracy, utility, and cost-effectiveness of automated systems, many of which are not able to detect each of the key moments of HH for an HCW.

Key Questions:

  • Do electronic HH monitoring systems accurately assess HH compliance?
  • Are electronic HH monitoring systems effective at improving compliance with HH protocols and reducing rates of HAIs?
  • Are electronic HH monitoring systems associated with any harmful effects to HCWs or patients?