Monitoring Compliance with WHO's '5 Moments for Hand Hygiene'

Vincent C.C. Cheng, of the Department of Microbiology at Queen Mary Hospital in Hong Kong, and colleagues, report on their study involving MedSense, an electronic hand hygiene compliance monitoring system that provides infection preventionists with continuous access to hand hygiene compliance information by monitoring Moments 1 and 4 of the World Health Organization (WHO)'s "5 Moments for Hand Hygiene" guidelines. The researchers say that unlike previous electronic monitoring systems, MedSense operates in open cubicles with multiple beds and does not disrupt existing workflows.

This study was conducted in a six-bed neurosurgical intensive care unit with technical development and evaluation phases. Healthcare workers (HCWs) wore an electronic device in the style of an identity badge to detect hand hygiene opportunities and compliance. We compared the compliance determined by the system and an infection control nurse. At the same time, the system assessed compliance by time of day, day of week, work shift, professional category of healthcare workers, and individual subject, while the workload of HCWs was monitored by measuring the amount of time they spent in patient zones.

During the three-month evaluation phase, the system identified 13,694 hand hygiene opportunities from 17 nurses, three physiotherapists, and one healthcare assistant, resulting in an overall compliance of 35.1 percent for the unit. The per-indication compliance for Moment 1, 4, and simultaneous 1 and 4 were 21.3percent (95%CI: 19.0, 23.6), 39.6percent (95%CI: 37.3, 41.9), and 49.2percent (95%CI: 46.6, 51.8), respectively, and were all statistically significantly different (p<0.001).

In the four 20-minute sessions when hand hygiene was monitored concurrently by the system and infection control nurse, the compliance rates were 88.9 percent and 95.6 percent respectively (p=0.34), and the activity indices were 11.1 and 12.9 opportunities per hour, respectively. The hours from 12:00 to 14:00 had a notably lower compliance (21.3%, 95%CI: 17.2, 25.3) than nearly three quarters of the other periods of the day (p<0.001). Nurses who used shared badges had significantly (p<0.01) lower compliance (23.7%, 95%CI: 17.8, 29.6) than both the registered nurses (36.1%, 95%CI: 34.2, 37.9) and nursing officers (34.0%, 95%CI: 31.1, 36.9) who used named badges.

The researchers conclude that MedSense provides an unobtrusive and objective measurement of hand hygiene compliance and that the information is important for staff training by the infection control team and allocation of manpower by hospital administration. Their research was published in BMC Infectious Diseases.

Reference: Cheng VCC, Tai JWM, Ho SKY, Chan JFW, Hung K, Ho P and Yuen K. Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology. BMC Infectious Diseases 2011, 11:151doi:10.1186/1471-2334-11-151.