The Unbridled Potential of Electronic Hand Hygiene Monitoring Systems


In the fight against health care-associated infections, EHHCM systems are a key weapon.

Hand hygiene   (Adobe Stock, unknown)

Hand hygiene

(Adobe Stock, unknown)

Infection control became an established discipline in US hospitals in the 1950s, unleashing an infection prevention movement that, over the last 70 years, led to the acceptance of proper hand hygiene as the most effective way to reduce health care-associated infections (HAIs) as well as the establishment of hand hygiene adherence recommendations, guidelines, and performance criteria.1

To help health care providers follow those strategies, improve hand hygiene adherence, and reduce the incidence of HAIs, several manufacturers have introduced electronic hand hygiene adherence monitoring (EHHCM) systems.2 These systems use wireless technology to automate and standardize hand hygiene data collection, turn that data into meaningful insights, and help drive sustained behavior and culture changes.

Following is a look at some of the key functions and benefits of EHHCM systems and some important considerations for infection preventionists looking to improve their HAI outcomes.

Monitoring & Data Collection

Since these solutions are called electronic hand hygiene adherence monitoring systems, monitoring is a core capability, allowing for collecting vital hand hygiene adherence data. Some systems provide electronic group monitoring, and others offer electronic individual monitoring.

With group monitoring, sensors installed in soap and sanitizer dispensers throughout the facility keep count of how many times each dispenser is used. That total is divided by the number of employees to reach a group adherence score. It should be noted that a group monitoring system does not distinguish between employees, patients, or visitors, which can lead to inaccuracies in a facility’s overall adherence rate.

Individual monitoring is also generally accomplished with sensors installed in soap and sanitizer dispensers throughout the facility. Still, with individual monitoring, those sensors connect with an employee’s badge to track when and where that employee participated in or missed a hand hygiene opportunity.

One additional EHHCM system takes individual monitoring even further by leveraging a wearable device that dispenses hand sanitizer, monitors adherence, and provides the employee with up-to-date performance information. This system aims to drive sustained adherence not only by collecting and immediately sharing employee-specific hand hygiene data but by literally putting hand sanitizer in the palm of the employee’s hands—with no disruption to the workflow, no disengagement with the patient, and no turning toward or walking to a wall-mounted dispenser. This system also includes a built-in direct observation web application that integrates data collected through direct individual observation with data collected through electronic monitoring for the greatest visibility into staff performance.

Insights and Reporting

Electronic monitoring systems greatly benefit from monitoring and collecting all that rich and accurate adherence data. However, most go even further by analyzing the data, turning it into actionable insights, and sharing it in real-time on a user-friendly dashboard.

For example, group monitoring insights offer a broad perspective of overall adherence that can help gauge an organizational commitment to adherence, identify facility spaces where adherence is especially favorable or unfavorable, and highlight potential training shortfalls. Lacking, however, is a line of sight into where hand hygiene is being performed within the workflow and by whom.

On the other hand, by identifying when, where, and by whom hand hygiene was performed or missed, including at the point of care and by the World Health Organization’s 5 Moments for Hand Hygiene,3 individual monitoring systems allow infection preventionists to work with each health care worker to identify personal adherence goals, develop a targeted education and training protocol, and assign individualized tactics to overcome barriers to adherence. In addition, infection preventionists can create personalized reward and reinforcement programs to help drive sustained adherence.

With some EHHCM systems, the reporting dashboard is only accessible by management, while others also allow each health care worker to access their personal information. The benefit of employee access is that it encourages employees to maintain consistent awareness of their performance to actively strive to make changes as needed. Employee access can also drive empowerment, with the employee taking ownership of their ability to improve adherence.

Culture, Complexity, and Cost

In evaluating EHHMC systems, keeping organizational culture in mind is vital. This involves carefully considering what policies, behaviors, activities, and beliefs are in place that impact the delivery of patient care and determining if an electronic monitoring system will work within the existing cultural framework. If it will, are there components or capabilities of one system over another best aligned with the current culture? If it won’t, is there a willingness among the facility’s stakeholders and decision-makers to make the cultural changes needed for this type of system to succeed?

Infrastructure and budget are additional considerations. The more components the EHHCM system has, the more complex it is. The more complex it is, the more likely it is to require support from internal or external IT resources and integration into an existing technology infrastructure, and the more expensive the solution may be both in the short term and the long term.

EHHMC systems are gaining ground in health care facilities across the country. Still, the success of these systems depends on health care providers being diligent in their product research, thoughtful in their system selection, committed to staff adoption and adherence, and collaborating with the system vendor. Similarly, the success of EHHMC systems as a viable adherence tool within health care requires vendors to be an extension of the provider’s team, a partner in training and troubleshooting, and dedicated to helping the provider achieve sustained hand hygiene adherence, reduced HAIs, and improved patient outcomes.

Ashley Butler is vice president and general manager of Skincare at GP PRO, a division of Georgia-Pacific and a leading manufacturer of hygienic solutions for health care for 50 years.


  1. Morbidity and Mortality Weekly Report. CDC. Oct. 7, 2011, Accessed August 29, 2023.,centers%2C%20not%20in%20public%20health%20agencies.&text=By%20the%20late%201950s,in%20public%20health%20agencies.&text=late%201950s%20and%20early,centers%2C%20not%20in%20public
  2. Boyce, J M. Measuring healthcare worker hand hygiene activity: Current practices and emerging technologies.” National Library of Medicine, Aug. 24, 2011,
  3. Chou DT, Achan P, Ramachandran M. The World Health Organization '5 moments of hand hygiene': the scientific foundation. J Bone Joint Surg Br. 2012;94(4):441-445. doi:10.1302/0301-620X.94B4.27772
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