Hand Hygiene Compliance Systems

Hand Hygiene Compliance Systems: Growing Trend in Healthcare

Kathy Cunningham


By Kathy Cunningham, RN, BSEd, CNN

We have all either been a patient in a healthcare facility or have had a relative or friend who has been one. Any individual who enters this setting puts their trust in healthcare workers to provide safe and competent care at all times. Unfortunately, healthcare associated infections (HAIs) represent a major global patient safety concern. Nearly 2 million HAIs and 100,000 HAI-related deaths occur annually in the United States alone.1-3  

So what can be done to improve these alarming statistics?

Proper performance of hand hygiene at key moments during patient care is the most important means of preventing healthcare associated infections.4 Did you know that an ICU nurse could have as many as 240 opportunities to perform hand hygiene during their 12 hour shift?5  With increasing awareness of the cost and impact of HAIs, healthcare facilities are realizing that hand hygiene improvement initiatives are critical.

The most commonly used method to measure hand hygiene compliance today in healthcare settings is direct observation. However, technology can enhance the direct observation process by using a tablet application to count and record hand hygiene observations and create reports. Technology can also provide an automated method for capturing hand hygiene opportunities and events 24/7 in an unbiased manner. While there are a variety of technologies available, many of them perform similar functions. They generate a numerator (hand hygiene events), denominator (opportunities for hand hygiene) and then interpret and display hand hygiene compliance in a series of real time dashboards.

There are several types of electronic monitoring systems available. An activity based/community based system functions so that all who enter or exit a patient room (healthcare workers, patients, visitors) are monitored for hand hygiene compliance. Another compliance monitoring system uses the Real Time Locator System (RTLS) badge which can be worn by specified healthcare providers. The RTLS system records “wash in/wash out” opportunities and wash events. Some systems use radio frequency identification (RFID) badges, which can issue reminders and indicators of hand hygiene compliance at the point of care. A final method of measuring compliance electronically is video recording which requires someone watching the videos to provide feedback.

Electronic hand hygiene compliance monitoring is a new frontier in Infection Control programs. Healthcare facilities should consider an electronic compliance system not only to measure hand hygiene compliance, but also to act on the trends identified in the data. This can ultimately provide better patient outcomes.

1 Agency for Healthcare Research and Quality. 2010 National Healthcare Quality Report Patient Safety. Rockville, MD: US Department of Health and Human Services; 2010.
2 Klevens RM, Edwards JR, Richards CL Jr. Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007; 122: 160-6.
3 Jarvis WR. The Lowbury lecture. The United States’ approach to strategies in the battle against healthcare-associated infections, 2006: transitioning from benchmarking to zero tolerance and clinician accountability. J Hosp Infect 2007; 65 (Suppl 2): 3-9.
4 Pincock, T. et al. (2012) Bundling hand hygiene interventions and measurement to decrease health care-associated infections. American Journal of Infection Control. 40. S18-S27.
5 Kirk, J.M (2013) Hand hygiene compliance measurement. Available from        http://www.infectioncontroltoday.com/whitepapers/2013/05/hand-hygiene-compliance- measurement.aspx

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