Real-Time Computerized Feedback Improves Hand Hygiene Technique

Researchers from Trinity College Dublin in Ireland, the Department of Health in London, and Mid Essex Hospital Services in Chelmsford, UK, say that occlusion of observers' views make it difficult to audit hand hygiene technique. They investigated the effect of computerized video observation and real-time feedback on hand hygiene technique.

Handwash monitors (SureWash, Ireland) were placed above clinical sinks in a 28-bed surgical ward. The clinical trial consisted of four phases: Phase 1 (one week) determined the baseline practice without any feedback. Phase 2 (four weeks) provided real-time feedback. In Phase 3 (five weeks) a printed report was also presented at the weekly staff meeting. In Phase 4 (one week) the feedback was turned off. The feedback was shown on a computer screen of each unit. SureWash deemed a handwashing complete if it followed every step of the CleanYourHands protocol.

The researchers report that the number of handwash events (HWE) for each day was divided by the product of the number of patients and staff. The daily averages of HWE were 0.14±0.01, 0.36±0.02, 0.35± 0.02, 0.18±0.2 for phases 1, 2, 3 and 4 respectively. The increase between phase 1 and 2 was 156% percent (p<10-7) and the fall in phase 3 from 4 was 48 percent (p<10-4). The daily average number of completed HWE was 0.02±0.004, 0.17±0.01, 0.16±0.18, 0.02±0.005 in phases 1, 2, 3 and 4 respectively. The increase between phase 1 and 2 was 703 percent (p<10-9) and the fall in phase 3 from 4 was 48 percent (p<10-3). The total completion rates were: 15.8 percent (38/240), 49.1 percent (719/1464). 44.4 percent (724/1630) and 13.3 percent (24/180) in each phase respectively.

Ghosh, et al. conclude that real-time computerized feedback on proper technique resulted in a significant increase in the number of HWE (+156 percent) and in the adherence (+703 percent) to the CleanYourHands protocol. Feedback acted as a reminder of technique and provided instruction on "difficult" poses. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland June 29-July 2, 2011.

Reference: A Ghosh, G Lacey, C Gush and S Barnes. The impact of real-time computerized video analysis and feedback on hand hygiene practice and technique on a surgical ward. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):O52doi:10.1186/1753-6561-5-S6-O52

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