From “Gotcha” to Coaching: Using RTLS to Improve Hand Hygiene

Hand hygiene remains one of the most fundamental defenses against health care-associated infections (HAIs), yet measuring its consistency remains challenging. Traditional direct observation captures only a fraction of daily hand hygiene opportunities and can provide an incomplete picture of behavior across a health care facility.

In an interview with Infection Control Today^®(ICT^®), Danielle Updegraff, MBA, BSN, RN, principal consultant at CenTrak, discussed how real-time location systems (RTLS) are evolving beyond simple tracking tools to provide infection preventionists (IPs) with actionable information about hand hygiene, workflow, and potential infectious disease exposures.

According to Updegraff, one of the most significant developments has been the transition from viewing RTLS primarily as a locating technology to using it as an infection prevention intelligence tool.

For hand hygiene, this can mean replacing small samples of manually observed behavior with more consistent data on room entries, exits, and hand hygiene events. The resulting data can reveal differences by unit, role, shift, or workflow, helping IPs identify where additional education or process improvements may be needed.

“The biggest advancement is RTLS is moving infection prevention from isolated observations to a continuous actionable visibility,” Updegraff said.

Avoiding the “Gotcha” Culture

More data, however, does not automatically create better infection prevention. Staff may resist monitoring technology if they believe it will primarily be used to identify and punish individuals.

Updegraff said successful organizations deliberately position RTLS as a tool for improvement rather than enforcement. When performance declines, she recommends that leaders resist beginning with the question of who failed to perform hand hygiene. Instead, they should ask why.

“Are the dispensers in the right place? Are there workflow challenges? You know, are there education opportunities? Is staffing impacting behavior?” she said.

That distinction can turn hand hygiene data into an opportunity for frontline staff to participate in problem-solving. Employees can identify practical barriers that administrators or IPs may not recognize, while leaders can demonstrate that staff feedback results in meaningful changes.

Technology Cannot Create Culture

RTLS also cannot compensate for an organization that lacks leadership engagement or a strong safety culture. Updegraff emphasized that sustainable hand hygiene improvement should not be treated simply as a technology implementation.

“Hand hygiene improvement, it’s not a technology project; it’s a culture and a process improvement initiative that is supported by the technology,” she said.

Technology provides objective data, but long-term improvement requires education, workflow changes, frontline engagement, and leaders who continue emphasizing hand hygiene after the initial implementation period.

Organizations seeing the greatest success, she explained, regularly review performance, celebrate improvement, involve frontline workers in problem-solving, and continuously search for ways to make desired behaviors easier.

“Technology provides the visibility, but it’s the people and processes and the culture [that] really ultimately drive that long-term success,” Updegraff said.

Beyond Hand Hygiene

RTLS may also provide IPs with valuable information during outbreak investigations and exposure assessments. When an infectious disease event occurs, teams often need to determine quickly who entered an area, how long individuals remained there, and who or what may have been exposed.

Rather than depending entirely upon interviews, recollections, and manual reconstruction, location information can help teams reconstruct movement patterns and assess potential contacts.

“Visibility really, it boils down to visibility,” Updegraff said. “Because you can’t prevent what you can’t see.”

The combination of location awareness and actionable data, she explained, can help shift infection prevention from retrospective investigation toward more timely situational awareness.

For IPs considering RTLS, Updegraff recommends starting not with the technology but with the problem they are trying to solve. Reliable location information, useful analytics, reporting capabilities, and integration into existing workflows are important, but technology alone will not solve an infection prevention challenge.

Ultimately, she said, the important question is not whether a system can collect information. It is whether the organization can turn that information into safer practices and better outcomes.

That distinction may be particularly important for hand hygiene. Electronic monitoring can dramatically expand visibility beyond limited direct observations, but its value depends on what happens next: identifying barriers, coaching staff, improving workflows, and creating a culture in which the data supports both patient and health care worker safety.