Automated monitoring: a potential solution for achieving sustainable improvement in hand hygiene practices.

Adequate hand hygiene is often considered as the most effective method of reducing the rates of hospital-acquired infections, which are one of the major causes of increased cost, morbidity, and mortality in healthcare. Electronic monitoring technologies provide a promising direction for achieving sustainable hand hygiene improvement by introducing the elements of automated feedback and creating the possibility to automatically collect individual hand hygiene performance data. The results of the multiphase testing of an automated hand hygiene reminding and monitoring system installed in a complex continuing care setting are presented. The study included a baseline Phase 1, with the system performing automated data collection only, a preintervention Phase 2 with hand hygiene status indicator enabled, two intervention Phases 3 and 4 with the system generating hand hygiene reminding signals and periodic performance feedback sessions provided, and a postintervention Phase 5 with only hand hygiene status indicator enabled and no feedback sessions provided. A significant increase in hand hygiene performance observed during the first intervention Phase 3 was sustained over the second intervention Phase 4, with the postintervention phase also indicating higher hand hygiene activity rates compared with the preintervention and baseline phases. The overall trends observed during the multiphase testing, the factors affecting acceptability of the automated hand hygiene monitoring system, and various strategies of technology deployment are discussed.