Obstacles to the successful introduction of an electronic hand hygiene monitoring system, a cohort observational study

Abstract

Background Hand hygiene (HH) compliance remains low in many intensive care units (ICU). Technology has been suggested to improve HH compliance. We describe the introduction of an electronic HH surveillance and intervention system into the general ICU of a tertiary care teaching hospital, the obstacles to success and reasons for the system’s ultimate failure and removal. Methods The system was based on radiofrequency transmitters in patient areas, on HH dispensers, and individual personal bracelets. The transmitters were connected to a central computer. The system was designed to detect entry and exit from patient areas and provide real time alerts of missed HH performance . A staff satisfaction questionnaire was administered followed by validation of system accuracy. Electronic data were compared to human observer data collected during defined observation periods. Results Data from 41 questionnaires revealed low satisfaction rate (21/41, 51%). Low system accuracy (31/41, 76%) and inconvenience (18/41, 44%) being the most frequent reasons. During 44 one hour observation periods the observer recorded more HH opportunities and performances than the electronic system (mean number of HH opportunities/hour 10.9 ± 7.6 vs 6.8 ± 6.9, p < 0.001, correlation r = 0.75, p < 0.001, and performances/hour 8.7 ± 3.9 vs 6.0 ± 3.1, p < 0.001, correlation r = 0.60, p < 0.001, respectively). Correlation between observer and HH electronic system was very low (correlation coefficient r = 0.03, p = 0.91). Conclusions The electronic HH system was not accepted by ICU staff principally due to inaccuracy and inconvenience. Inaccuracies were verified by direct observations. In order for an electronic HH system to succeed we suggest it must be highly accurate and comfortable to use.

Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections

“…[10][11][12][13] Automated hand hygiene monitoring systems (AHHMSs) are increasingly common, [14][15][16] but they have varying accuracy. 9,[17][18][19][20][21][22][23] Some AHHMSs record the use of alcohol-based hand rub (ABHR) and soap, while others record the number of times dispensers are used and compare that to an estimated number of hand hygiene opportunities. 24 These systems can accurately estimate an aggregate adherence rate for a hospital, unit, or individual room within a hospital, but they cannot distinguish between healthcare worker (HCW) types or provide individualized HCW data.…”

Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology

“…All the 89 reviewed studies were published between 2009 and 2020, with 9 (10%) dated in or before 2010 [ 42 , 46 , 56 , 60 , 81 , 83 , 86 , 92 , 113 ], 38 (43%) dated between 2011 and 2015 [ 32 , 33 , 36 , 38 , 39 , 45 , 48 , 49 , 51 , 52 , 54 , 59 , 61 , 63 - 65 , 67 , 68 , 72 , 73 , 78 - 80 , 82 , 84 , 87 - 89 , 93 - 97 , 99 - 101 , 108 , 116 ], and 42 (47%) dated in or after 2016 [ 25 , 29 - 31 , 34 , 35 , 37 , 40 , 41 , 43 , 44 , 47 , 50 , 53 , 55 , 57 , 58 , 62 , 66 , 69 - 71 , 74 - 77 , 85 , 90 , 91 , 98 , 102 -…”

“…Of the 32 studies, 10 (31%) developed or deployed an RFID-based RTLS [ 71 , 73 , 75 , 76 , 83 , 84 , 90 , 93 , 97 , 99 ]. RFID uses radio waves to identify and track tags attached to objects.…”

Comparison of two electronic hand hygiene monitoring systems in promoting hand hygiene of healthcare workers in the intensive care unit

“…Vaisman A et al [ 25 ] found that the number of HHEs recorded by EHHMS was 2.5 times higher when the observer was present than absent, and the difference may be attributed to the Hawthorne effect. Besides, the EHHMS was not as accurate as of the direct observation method in the identification of HH indicators [ 26 ], so more HH moments were recorded [ 27 ].…”

“…However, EHHMS also has some limitations [ 12 , 16 , 26 ], such as the inability to monitor the correctness of HH, which usually costs a lot, and the failure to follow the five HH moments recommended by WHO adequately. The type2 system in this study, like many systems [ 24 , 28 ], can only detect 1, 4, and 5 of the five WHO’s HH moments, but not 2 and 3.…”