How Emerging Technologies Increase Hand Hygiene Adherence and Reduce Infections

Infection Control TodayInfection Control Today, May/June 2024 (Vol. 28 No.3)
Volume 28
Issue 3

Health care-associated infections (HAIs) affect over 680,000 patients annually in the U.S. Unlike manual methods, automated hand hygiene monitoring can significantly improve compliance and reduce HAIs.

Figure 1. An example of a real-time location system.   (Image credit: CenTrak)

Figure 1. An example of a real-time location system.

(Image credit: CenTrak)

Health care–associated infections (HAIs) remain a critical patient safety concern in health care facilities across the US. Recent statistics show that more than 680,000 infections occur each year in the US alone, with costs reaching into the billions of dollars.1 Approximately 1 in every 31 hospital patients has at least 1 HAI. While progress has been made in preventing these infections, this remains an unacceptable outcome that negatively impacts patients and health care professionals.

Over the last few years, the health care industry has paid significant attention to hand hygiene adherence, as countless health officials have stressed its importance. According to the CDC,2 consistent hand hygiene is the most crucial tool for helping prevent infection transmission and control outbreaks. However, achieving high and consistent hand hygiene adherence remains challenging in health care settings.

Even so, this issue has a relatively simple solution: automated hand hygiene monitoring devices that use real-time location sensors to monitor hand hygiene events and provide comprehensive data.

Hand hygiene systems develop best practices in staff, increase adherence to hospital policies, and mitigate the risks associated with HAIs. Successfully implementing an electronic hand hygiene monitoring system3,4 can improve results, mainly when the system provides real-time insights and a thoughtful approach to guided change management is taken from the start. As outlined below, strategically implementing an electronic hand hygiene system can result in several benefits.

Why Implementing Real-Time Technology Helps Increase Hand Hygiene Adherence

Many hospitals use manual observation methods when reporting and increasing hand hygiene adherence.4 Still, this time-consuming, ineffective approach takes only a snapshot of daily handwashing activity and usually excludes data from night shifts, understaffed units, weekends, and holidays. Alternatively, an electronic hand hygiene solution automatically captures and reports all possible handwashing events by department, role, and individual, allowing actionable improvements in adherence while flagging areas for growth and reducing rates of HAIs. Figure 1.

The technology behind a real-time location system (RTLS)5 includes radio-frequency identification location-enabled badges that wirelessly communicate with hand hygiene sensors embedded within dispensers, sinks, and handwashing stations. An RTLS-based hand hygiene monitoring solution supports custom settings for specific rooms, such as using soap vs sanitizer or time frames for expected hand hygiene adherence upon entering a room. An RTLS that detects both the presence of a badge and the use of a dispenser, in conjunction with patient care, provides more accurate information on missed opportunities and adherence trends.

Even though infection preventionists (IPs) and health care leaders have implemented hand hygiene policies, recommendations, and adherence procedures for decades, not all facilities are equipped with the latest technology. Many facilities across the country still use manual processes. The manual process, known as the secret shopper method, provides a limited dataset and proves costly, time intensive, and burdensome for IP teams. Additionally, it introduces vulnerabilities such as human error, biases, and the Hawthorne effect (when habits temporarily change due to being observed),6 compromising data accuracy. Instead, an electronic system reallocates valuable time for IPs to work on preventing, detecting, and coaching to improve hand hygiene practices.

Electronic monitoring and real-time insights offer a more comprehensive, efficient, and effective method of monitoring hand hygiene events. They provide an all-encompassing view of handwashing activities that is unbiased when identifying adherence and nonadherence. Electronic monitoring can help facilities flag where additional support or education is necessary to establish best practices for handwashing habits. Advanced systems can also offer custom real-time reminders to perform handwashing before a patient interaction occurs, further reducing the risk of spreading HAIs.

Increase the Success Rate of Your Implementation With a Thoughtful Approach

As health care leadership considers the best fit for their hand hygiene adherence monitoring needs, some of the top solution providers supply a secure, high-performance cloud environment for their software applications. Scalable cloud-based software simplifies implementation and maintenance, reducing costs and easing the labor-intensive management typically associated with physical servers. Upon reviewing Software as a Service options, select 1 that provides unified access to a comprehensive suite of RTLS solution applications (ie, staff duress, asset tracking, clinical workflow, etc) and wider system management tools with single sign-on capabilities. Utilizing a cloud environment provides automatic and proactive application updates and further eases processes for health care professionals. Essential functions such as user management, staff assignments, facility maps, site structures, and device configurations can be consolidated into 1 RTLS platform. Figure 2.

Figure 2. An example of a real-time location system platform.  (Image credit: CenTrak)

Figure 2. An example of a real-time location system platform.

(Image credit: CenTrak)

Staff support and stakeholder buy-in can be significant considerations when implementing new technology or equipment. The key to buy-in success is early goal transparency, proactive communications, and staff education on the technology’s use cases. Successfully deploying and earning support for new solutions requires incorporating the proper expertise within the health care facility, vendor, and key stakeholders from the relevant departments that will play a role. Bringing together leadership with varied viewpoints and expertise allows health care facilities to better develop the implementation roadmap, communication plans, and comprehensive educational programs. By providing transparency and education on the technology’s purpose and benefits, health care professionals are likelier to adopt the technology and see its value. This is especially important when it comes to new safety tools. Without widespread staff adoption, the solutions won’t be as effective nor bring the desired return on investment.

A medical center in Denver, Colorado, improved its hand hygiene adherence rates by 30% by following a thoughtful approach to implementing an RTLS-based hand hygiene compliance solution.7 Previously, the medical center relied on a manual process, documenting only a few hundred observations monthly within regular business hours at the 500-bed facility. With the introduction of an electronic hand hygiene monitoring system, real-time data collection now captures 100% of handwashing events. This enables continuous auditing of facility-wide adherence. The system generates adherence reports in alignment with The Joint Commission requirements and offers analytical insights into areas necessitating further education and training.

Similarly, a Georgia health care facility implemented the same hand hygiene solution, remarkably improving hygiene adherence. This achievement positions the facility among the nation’s top performers in maintaining consistent adherence standards of over 90%. Furthermore, the facility’s cost of HAIs has dropped by more than $400,000 since reenergizing its hand hygiene adherence campaign.8

Actionable Data Bring a Better, Healthier Experience

The most powerful feature of the RTLS electronic hand hygiene adherence system is the real-time actionable analytics. These insights, gathered across designated areas, hospital-wide, or an entire health system or integrated delivery network, are seamlessly and automatically relayed to IPs and hospital administrators via the system’s dashboard. Hand hygiene events can then be audited by unit, time of day, room, and individual to review adherence, consider trends, and pinpoint areas needing improvement. These reports can be automatically delivered on a custom schedule and offer real-time awareness of operations, identifying the need for additional interventions (such as increased staff training or a change in clinical workflow) where adherence is lower. To encourage adherence and boost morale, intel should be used to celebrate high performance and share best practices across the health system.

Strategically implementing automated monitoring solutions can significantly reinforce hand hygiene best practices among staff, enhancing the patient care experience and optimizing care delivery. Concurrently, IPs can focus on targeted areas for improvement, ultimately assisting in improving hospital finances. Hospitals embracing enterprise location technology throughout their facilities have real-time access to actionable data to mitigate threats like HAIs. Moreover, utilizing an RTLS solution as a foundational tool empowers hospitals and health care facilities to scale operational capabilities as needed. This includes solutions ranging from staff duress and nurse call automation to workflow and asset management, ensuring adaptability and efficiency for future needs.


  1. Rhee C, Dantes R, Epstein L, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA. 2017;318(13):1241. doi:10.1001/jama.2017.13836
  2. Hand hygiene in healthcare settings. CDC. April 28, 2023. Accessed April 25, 2024.
  3. Hand hygiene compliance monitoring. CenTrak Inc. Accessed 25, 2024.
  4. Genovesi G. Infection Control Today exclusive: the challenge of health care-associated infections (HAIs) and evolving prevention: a focus on hand hygiene. Infection Control Today. November 6, 2023. Accessed April 25, 2024.
  5. Infection Control Today Editorial Staff. CenTrak unveils revolutionary BLE Multi-Mode Platform for health care RTLS solutions. Infection Control Today. March 22, 2024. Accessed April 25, 2024.
  6. Srigley JA, Furness CD, Baker GR, Gardam M. Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. BMJ Qual Saf. 2014;23(12):974-980. doi:10.1136/bmjqs-2014-003080
  7. Centrak Resource Center: case studies. CenTrak Inc. Accessed April 25, 2024.
  8. Nadeau K. The contagion contingent. Healthcare Purchasing News. February 22, 2022. Accessed April 24, 2024.

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