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Table 3 Review of literature on the use of electronic device in monitoring hand hygiene

From: Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology

Study [reference] Design, setting, and main intervention Major outcome and remark
Swoboda SM
et al (2004)
[12]
Prospective 14-month study in a 14-bed intermediate care unit, Baltimore, US;
Electronic monitoring system to record entry and exit from patient rooms, the use of toilet and dirty utility facilities, and the use of hand washing and hand hygiene devices;
Phase 1 (6-month): electronic monitoring and 8-weeks of direct observation of staff interactions;
Phase 2 (6-month): voice-prompt system giving prerecorded messages to remind the individual to wash hands if they had not done so before exiting the room or within 10 seconds in one of the sinks and dispensers;
Phase 3 (2-month): electronic monitoring without voice-prompt system
Hand hygiene compliance in patient rooms improved by 37% during phase 2 and 41% in phase 3; while the number of infection decreased by 22% and 48% in the corresponding period;
Patient care practice was not precisely observed
Kinsella G
et al (2007)
[13]
A 47-day study in a 16-bed ICU, Salford, UK;
Electronically record the use of wall-mounted soap and alcohol gel dispensers implanted in two bed areas and entrance of ICU;
Measure the consumption pattern of wall-mounted soap and alcohol gel dispenser
Consumption of alcohol gel dispenser in bed area was correlated with the dependency of the patient (r = 0.5, p < 0.01);
Compliance of hand hygiene was not measured
Venkatesh AK
et al (2008)
[14]
Prospective 1-month study in a 30-bed hematopoietic stem cell transplantation & hematology unit, Chicago, US;
Audible alert to prompt healthcare workers to perform hand hygiene on 12 electronically monitored rooms upon entry and exit;
Phase 1 (2-week): monitor baseline compliance of hand hygiene
Phase 2 (2-week): monitor hand hygiene compliance with automatic alerts
Improved compliance of hand hygiene from baseline (36.3%) to 70.1% during phase 2;
Patient care practice was not precisely observed
Marra AR
et al (2008)
[15]
A 6-month control trial in two 20-bed step-down units, Sao Paulo, Brazil;
Electronic counting devices for wall-mounted alcohol gel dispensers were available in two step-down units, one with feedback intervention program and one without (control)
No significant difference in the amount of alcohol gel used and hand hygiene compliance;
Patient care practice was not precisely observed
Boscart VM
et al (2008)
[16]
Descriptive study in teaching facilities, Ontario, Canada;
The wearable electronic monitoring device communicated with the alcohol gel dispensers and patient zone to provide signal to perform hand cleansing;
The acceptability and usability of wearable electronic hand wash device was assessed
All ten staff accept the use of the electronic device;
An individual patient environmental zone was defined
Boyce JM
et al (2009)
[17]
Prospective observation trial for 6-month in a 22-bed general medical ward and a 15-bed surgical ICU, New Haven, US;
Electronic device was used to record the frequency of dispenser used
The dispenser located in patient rooms account for 47% and 36% of hand hygiene events performed in surgical ICU and general medical ward respectively;
The hand hygiene event was indirectly measured by the dispenser used. The compliance of hand hygiene was not assessed
Sahud AG
et al (2010)
[18]
A 2-phase pilot study in 5 patient care units of a territory hospital, Pittsburgh, US;
Electronic device was installed in 20 patient room entrances and 70 dispensers for soap or hand sanitizer;
Phase 1 (8-month): manual observation at patient room entry and exit
Phase 2 (4-week): observation using electronic device
Electronic device captured 98% of manually recorded room entries and 95% of dispensing event;
The compliance was low (25.5%)
Edmond MB
et al (2010)
[26]
A 2-phase study in a 35-bed orthopedic ward,
Virginia, US; Volunteered nursing staff wore a credit-card-size alcohol sensor badge, which can detect alcohol vapor upon room entry or exit; if alcohol vapor was not detected within 8 s, the badge light would turn red and produce "beep" sound
Phase 1 (21 days): direct observation of hand hygiene compliance
Phase 2 (10 days): observation using electronic device
Compliance of hand hygiene among nursing staff increased from 73% in phase 1 to 93% in phase 2 (p = 0.01)
The system only measured compliance on room entry and exit; the hand hygiene opportunities occurred inside patient room were missed
Polgreen PM
et al (2010)
[27]
Description of an electronic device of small credit-card-sized without radio-frequency identification to monitor the use of hand hygiene dispensers before healthcare workers enter or exit patient rooms No clinical data being mentioned
  1. ICU, intensive care unit