Validation of an Aggregate Electronic Monitoring System for Hand Hygiene

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.

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Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology

BMC Infectious Diseases ◽

10.1186/1471-2334-11-151 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 61

Author(s):

Vincent CC Cheng ◽

Josepha WM Tai ◽

Sara KY Ho ◽

Jasper FW Chan ◽

Kwan Ngai Hung ◽

...

Keyword(s):

Hand Hygiene ◽

Monitoring System ◽

Electronic Monitoring

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1202: EFFECTIVENESS OF ELECTRONIC MONITORING SYSTEM ON HEALTHCARE WORKERS’ COMPLIANCE WITH HAND HYGIENE

Critical Care Medicine ◽

10.1097/01.ccm.0000811132.77968.1f ◽

2021 ◽

Vol 50 (1) ◽

pp. 600-600

Author(s):

Kalyan Prudhvi ◽

Muhammad Javed ◽

Farid Sadaka

Keyword(s):

Hand Hygiene ◽

Monitoring System ◽

Healthcare Workers ◽

Electronic Monitoring

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1187. Estimation of Individual Healthcare Workers’ Relative Hand Hygiene Compliance Using an Anonymous Electronic Monitoring System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1050 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S425-S426 ◽

Cited By ~ 1

Author(s):

Maxime-Antoine Tremblay ◽

Mona Abou Sader ◽

Yves Longtin

Keyword(s):

Hand Hygiene ◽

Monitoring System ◽

Healthcare Workers ◽

Electronic Monitoring ◽

Tertiary Care ◽

Care Hospital ◽

Z Score ◽

Significant Difference ◽

Z Scores ◽

Individual Healthcare

Abstract Background The current hand hygiene (HH) auditing and feedback strategy include anonymized data collection using direct observation and feedback of aggregated data. We aimed to evaluate whether an anonymous (without wearable device) HH electronic monitoring system (EMS) could detect patterns associated with individual healthcare workers (HCWs) and estimate their relative HH performance. Methods Observational study of HH compliance via an EMS in 10 rooms in a tertiary care hospital. The EMS measures HH product dispenser activation (an indicator of HH events) as well as entries and exits from patient rooms (a surrogate of HH opportunities). HH rates were obtained by dividing the number of HH events by the number of opportunities. HH rates were aggregated at room-shift level (i.e., an 8-hour period for a single room). For each room-shift, the HH rate was converted to a Z score, which was then associated with the individual HCW assigned to that room-shift. The relative HH performance of individual HCWs was estimated by comparing the mean Z scores of each HCW with the rest of the group by the Student T-test, with a level of significance set at P < 0.001 after adjustment by Bonferroni’s correction. To investigate whether any association could be due to chance, we looked into the potential association between average Z scores and calendar days, as a counterexample. Results Over a 100-day period, there were 45 775 HH events and 136 821 opportunities (global compliance, 33%). Schedules were available for 2980 room-shifts. Fifty-four individual HCWs took part in at least one room-shift (average per HCW, 52 room-shifts; range 1–140). Eight HCWs (15%) had a mean Z score significantly above the group average (Figure 1, green boxes; mean Z score 0.71; range, 0.52 to 0.86; P < 0.001), whereas 9 HCWs (17%) had a significantly inferior Z score (Figure 1, red boxes; mean Z score -0.47, range -0.58 to -0.31, P < 0.001). In contrast, there was no significant difference in Z scores between calendar days (Figure 2; p >0.001). Conclusion Cross-linking a high-volume HH database with HCW schedules identified a significant association between individual HCWs and HH compliance in the rooms to which they were assigned. If confirmed in further studies, anonymous EMS could be used to provide HCWs with personalized relative HH compliance feedback. Disclosures All authors: No reported disclosures.

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Electronic hand hygiene monitoring systems can be well-tolerated by health workers: Findings of a qualitative study

Journal of Infection Prevention ◽

10.1177/17571774211012781 ◽

2021 ◽

pp. 175717742110127

Author(s):

D Kelly ◽

E Purssell ◽

N Wigglesworth ◽

DJ Gould

Keyword(s):

Hand Hygiene ◽

Monitoring System ◽

Electronic Monitoring ◽

Health Workers ◽

Qualitative Interviews ◽

Poor Performance ◽

Frontline Health Workers ◽

National Health Service Trust ◽

Personal Accountability ◽

The Uk

Background: Electronic hand hygiene monitoring overcomes limitations associated with manual audit but acceptability to health workers varies and may depend on culture of the ward and the nature of the system. Objectives: Evaluate the acceptability of a new fifth type electronic monitoring system to frontline health workers in a National Health Service trust in the UK. Methods: Qualitative interviews with 11 informants following 12 months experience using an electronic monitoring system. Results: Informants recognised the importance of hand hygiene and embraced technology to improve adherence. Barriers to hand hygiene adherence included heavy workload, dealing with emergencies and ergonomic factors related to placement of alcohol dispensers. Opinions about the validity of the automated readings were conflicting. Some health workers thought they were accurate. Others reported problems associated with differences in the intelligence of the system and their own clinical decisions. Opinions about feedback were diverse. Some health workers thought the system increased personal accountability for hand hygiene. Others ignored feedback on suboptimal performance or ignored the data altogether. It was hard for health workers to understand why the system registered some instances of poor performance because feedback did not allow omissions in hand hygiene to be related to the context of care. Conclusion: Electronic monitoring can be very well tolerated despite some limitations. Further research needs to explore different reactions to feedback and how often clinical emergencies arise. Electronic and manual audit have complementary strengths.

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A Study on the Policy Changes with Zahariadis’s MSM Applied : Centered about the Expansion of Those subject to the Electronic Monitoring System

Social Economy & Policy Studies ◽

10.22340/seps.2019.08.9.3.227 ◽

2019 ◽

Vol 9 (3) ◽

pp. 227-275

Author(s):

Dong-Hyo Han

Keyword(s):

Monitoring System ◽

Electronic Monitoring ◽

Policy Changes

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Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.518 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s38-s39

Author(s):

Jerome Leis ◽

Jeff Powis ◽

Allison McGeer ◽

Daniel Ricciuto ◽

Tanya Agnihotri ◽

...

Keyword(s):

Quality Improvement ◽

Hand Hygiene ◽

Electronic Monitoring ◽

Current Approach ◽

Antibiotic Resistant ◽

Guide Unit ◽

Cluster Randomized ◽

Healthcare Associated ◽

The Impact ◽

Inpatient Units

Background: The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Our goal was to assess the impact of group electronic monitoring coupled with unit-led quality improvement on HH performance and prevention of healthcare-associated transmission and infection. Methods: A stepped-wedge cluster randomized quality improvement study was undertaken across 5 acute-care hospitals in Ontario, Canada. Overall, 746 inpatient beds were electronically monitored across 26 inpatient medical and surgical units. Daily HH performance as measured by group electronic monitoring was reported to inpatient units who discussed results to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (%) between baseline and intervention. Secondary outcomes included transmission of antibiotic resistant organisms such as methicillin resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections. Results: After adjusting for the correlation within inpatient units, there was a significant overall improvement in HH adherence associated with the intervention (IRR, 1.73; 95% CI, 1.47–1.99; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1,395,450 of 4,544,144) to 37% (598,035 of 1,536,643) within 1 month, followed by consecutive incremental increases up to 53% (804,108 of 1,515,537) by 10 months (P < .0001). We identified a trend toward reduced healthcare-associated transmission of MRSA (0.74; 95% CI, 0.53–1.04; P = .08). Conclusions: The introduction of a system for group electronic monitoring led to rapid, significant, and sustained improvements in HH performance within a 2-year period.Funding: NoneDisclosures: None

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Objective Measures of Physical Distancing in the Hospital During the COVID-19 Pandemic

Journal of Hospital Medicine ◽

10.12788/jhm.3666 ◽

2021 ◽

Author(s):

Swetha Tatineni ◽

Nicola M Orlov ◽

Joseph M Riehm ◽

Amarachi Erondu ◽

Christine L Mozer ◽

...

Keyword(s):

Hand Hygiene ◽

Real Time ◽

Monitoring System ◽

General Medicine ◽

Optimal Level ◽

Objective Measures ◽

Real Time Monitoring

During the COVID-19 pandemic, hospitals published physical-distancing guidance and created dedicated respiratory isolation units (RIUs) for patients with COVID-19. The degree to which such distancing occurred between clinicians and patients is unknown. In this study, heat sensors from an existing hospital hand-hygiene monitoring system objectively tracked room entries as a proxy for physical distancing in both RIUs and general medicine units before and during the pandemic. The RIUs saw a 60.6% reduction in entries per room per day (from 85.7 to 33.8). General medicine units that cared for patients under investigation for COVID-19 and other patients experienced a 14.7% reduction in entries per room per day (from 76.9 to 65.1). While gradual extinction was observed in both units as COVID-19 cases declined, the RIUs had a higher degree of physical distancing. Although the optimal level of physical distancing is unknown, sustaining physical distancing in the hospital may require re-education and real-time monitoring.

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