Background: Hand hygiene is the first defense against healthcare-associated infections, yet studies show that adherence to hand hygiene still remains low. An academic medical center selected a beacon-based automated hand hygiene reminder system to improve hand hygiene adherence. Accountability is challenging to enforce without a reliable means to measure hand hygiene adherence. The hospital used secret shoppers to observe hand hygiene adherence. This method captures an estimated 0.5%–1.7% of opportunities and may be influenced by the Hawthorne effect. Methods: In November 2018, a phased trial of an electronic hand hygiene reminder system began in 4 intensive care units (ICUs). The system selected used a badge and beacon technology. The badge identifies each care provider and displays colored lights to show adherence status. Beacons are present on the patient’s bed, soap, and hand sanitizer dispenser. These beacons establish a “patient zone” that captures opportunities for hand hygiene. The specialty beds in the ICUs were supposed to remain on the units. A patient transferring to a lower level of care would be placed on another bed or gurney when leaving the ICU. ICU staff were badged for the system. Results: The phased implementation strategy had challenges with beds, badges, and the system. Despite planning, education, and communication, the beds left the ICU area, so the beaconed beds were outside the ICU, and staff did not always wear their assigned badge. There were issues with the system router as well. Unit leadership and the infection control team worked on processes to get beds back into the units. The implementation team decided to provide badges to staff who regularly worked in the ICU to differentiate from consultation groups that came to the ICU (and were not badged). The system routers were plugged in at various places on the units and had become unplugged so information was not sent for reports. Despite these issues, over the year of implementation, the units did achieve an increase in hand hygiene adherence from 48% to 85%. Collectively, the units achieved a 53% reduction in central-line–associated blood stream infection (CLABSI), reducing infections from 13 to 7 and a 35% reduction in methicillin-resistant Staphylococcus aureus (MRSA), reducing infections from 8 to 3 as defined by the NHSN. Conclusions: When implementing a beacon-based, automated hand hygiene system, staged implementation can be challenging. To avoid these challenges, facility-wide implementation is preferable.Funding: NoneDisclosures: None
Nurses’ compliance with central line associated blood stream infection prevention guidelines: observational study
