Hand hygiene monitoring technology: protocol for a systematic review

Abstract

BackgroundHealthcare worker hand hygiene is thought to be one of the most important strategies to prevent healthcare-associated infections, but compliance is generally poor. Hand hygiene improvement interventions must include audits of compliance (almost always with feedback), which are most often done by direct observation - a method that is expensive, subjective, and prone to bias. New technologies, including electronic and video hand hygiene monitoring systems, have the potential to provide continuous and objective monitoring of hand hygiene, regular feedback, and for some systems, real-time reminders. We propose a systematic review of the evidence supporting the effectiveness of these systems. The primary objective is to determine whether hand hygiene monitoring systems yield sustainable improvements in hand hygiene compliance when compared to usual care.Methods/DesignMEDLINE, EMBASE, CINAHL, and other relevant databases will be searched for randomized control studies and quasi-experimental studies evaluating a video or electronic hand hygiene monitoring system. A standard data collection form will be used to abstract relevant information from included studies. Bias will be assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Assessment Tool. Studies will be reviewed independently by two reviewers, with disputes resolved by a third reviewer. The primary outcome is directly observed hand hygiene compliance. Secondary outcomes include healthcare-associated infection incidence and improvements in hand hygiene compliance as measured by alternative metrics. Results will be qualitatively summarized with comparisons made between study quality, the measured outcome, and study-specific factors that may be expected to affect outcome (for example, study duration, frequency of feedback, use of real-time reminders). Meta-analysis will be performed if there is more than one study of similar systems with comparable outcome definitions.DiscussionElectronic and video monitoring systems have the potential to improve hand hygiene compliance and prevent healthcare-associated infection, but are expensive, difficult to install and maintain, and may not be accepted by all healthcare workers. This review will assess the current evidence of effectiveness of these systems before their widespread adoption.Study registrationPROSPERO registration number: CRD42013004519

Complex infection control strategies at the neonatal intensive care unit with a special focus on hand hygiene

“…In our proposed multistep intervention, posters were placed at the ward to draw the attention to current, specific IC problems. The posters as reminders address the issue of 'forgetting', which has been identified as a common cause of missed HH opportunities [127,158]. The efficacy of posters have been confirmed by Nevo et al reporting that compliance was improved when such posters were in the line of sight on entering the room [159].…”

“…The video monitoring technology may create an enhanced Hawthorne effect as HCWs become aware that they are being monitored on a continuous basis [158]. Additionally, the ability to provide more frequent and individual level feedback should improve compliance [182].…”

“…Ensuring the comparability of results depends, to a great degree, on the types of observer, the level and type of training that the observers receive, the duration of observation periods, and the number of HH opportunities observed [13,23]. Given these limitations, there is considerable interest in new technologies for audit and feedback of HH compliance, including electronic and video monitoring systems [24]. These new systems vary widely, ranging from simple systems that track only the number of times that soap or hand sanitizer is dispensed to complex systems that integrate information on the timing of HH dispensing events and the location of the HCW in order to provide an estimate of HH compliance [24].…”

“…Given these limitations, there is considerable interest in new technologies for audit and feedback of HH compliance, including electronic and video monitoring systems [24]. These new systems vary widely, ranging from simple systems that track only the number of times that soap or hand sanitizer is dispensed to complex systems that integrate information on the timing of HH dispensing events and the location of the HCW in order to provide an estimate of HH compliance [24]. Video monitoring means continuous monitoring of the patient environment via a video camera, with human reviewers assessing compliance.…”

“…[47] the incidence of infections (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).5%) at the NICUs depends on environmental factors and on differences in clinical practice.…”