Friday, September 16, 2016

Hand Hygiene Automated Monitoring Systems- Not Yet Ready for Prime Time

Back in 2009, Dr. Mike Edmond and I studied (probably) the 1st generation hand hygiene sensor technologies and published it in the Journal of Hospital Infection.  This technology sensed alcohol on healthcare worker hands and significantly increased compliance with hand hygiene (>90%). The study was small, involved a single unit with motivated and consented nursing participants. No clinical outcomes were assessed. Real world, sustained applicability was neither attempted nor demonstrated.

Monitoring hand hygiene is not easy and no infallible strategy exists to do so, as summarized here.         

We are once again attempting to implement, assess, and study hand hygiene monitoring technology in our hospital, this time using a stepped wedge trial design. The challenges are many, as very nicely summarized in this recent publication.   Having initially overcome the cost barriers, we are seeing hurdles such as getting front line worker buy-in, accuracy (when compared to the gold standard of direct observation), acceptability of being monitored, minimizing work-flow disruption and engagement of data and feedback. 

Hand hygiene technologies for monitoring compliance may have a significant role in the near future however it is not yet ready for prime time.