Going Touchless is a High-Tech Solution to Hand Hygiene Compliance

Recent studies indicate that electronic devices can play an important role in hand hygiene compliance. Venkatesh et al.²³ conducted a prospective, interventional study to evaluate the use of an electronic device to measure and impact hand hygiene practices and control transmission of VRE in a 30-bed academic medical center hematology unit. The researchers identified 8,235 measurable hand hygiene opportunities during the study, with compliance improvement from 36.3 percent at baseline to 70.1 percent during the second phase of the study. The use of audible alerts improved hand hygiene compliance for both the day shift and the night shift, as well as across rooms with higher HCW traffic and lower HCW traffic.

Swoboda et al.²⁴ attempted to determine through a three-phase study whether electronic monitoring of hand hygiene and voice prompts could improve hand hygiene and decrease infection rates in a 14-bed, university hospital-based surgical intermediate care unit. Phase I was electronic monitoring and direct observation; phase II was electronic monitoring and computerized voice prompts for failure to perform hand hygiene on room exit; and phase III was electronic monitoring only. All patient rooms, utility room and staff lavatory were monitored electronically. Participants included all healthcare personnel including physicians, nurses, nursing support personnel, ancillary staff, all visitors and family members, and any other personnel interacting with patients on the unit. All patients with an intermediate care unit length of stay greater than 48 hours were followed for hospital-acquired infections (HAIs). Electronic monitoring was conducted during all phases, with computerized voice prompts during phase II only. The researchers evaluated a total of 283,488 electronically monitored entries into a patient room with 251,526 exits for 420 days (10,080 hours and 3,549 patient days). Compared with phase I, hand hygiene compliance in patient rooms improved 37 percent during phase II and 41 percent in phase III. When adjusting for patient admissions during each phase, point estimates of HAIs decreased by 22 percent during phase II and 48 percent during phase III; when adjusting for patient days, the number of infections decreased by 10 percent during phase II and 40 percent during phase III. Although the overall rate of HAIs significantly decreased when combining phases II and III, the association between HAIs and individual phase was not significant. The researchers concluded that electronic monitoring provided effective ongoing feedback about hand hygiene compliance.

Swoboda et al.²⁵ also hypothesized that both patient isolation and electronic hand hygiene prompts incrementally improve hand hygiene of HCWs compared with non-isolation rooms. They conducted a prospective, 14.5-month, three-phase electronic surveillance study of hand hygiene behavior on an intermediate care unit with nine patient rooms (three isolation rooms and six non-isolation rooms); phase I was electronic observation, phase II was electronic observation with automated voice messages urging hand hygiene, and phase III was electronic observation. Electronic sensors monitored room entries and exits and use of all sinks and all soap dispensers. Phase I (1,616 patient-days) HCWs were 49 percent more likely to wash their hands in isolation rooms versus non-isolation rooms; phase II (1,390 patient-days) and phase III (543 patient-days) healthcare workers were 59 percent more likely to wash their hands in isolation versus non-isolation rooms, P = .001. The researchers concluded that HCWs improve hand hygiene when constrained by isolation rooms, that electronic voice prompts further improve hand hygiene behavior, and that both physical and auditory reminders improve hand hygiene. 

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