Electronic Hand Hygiene Monitoring: A Tool to Drive Improvement and Measure Impact

BACKGROUND: Hand hygiene (HH) is a basic principle of infection control, yet national HH adherence rates are only 40%. Challenges to improving HH rates include finding effective ways to promote and sustain change and collecting unbiased observations to measure the success of interventions. Our institution implemented an electronic HH (eHH) monitoring system on select hospital units with the goal of using this technology to both improve and measure HH rates. METHODS: In Apr 2016, Denver Health installed the HillRom Hand Hygiene Compliance Solution in 4 inpatient units (2 adult wards, 1 intensive care unit, and 1 progressive care unit). Sensors were installed on all HH dispensers and at the thresholds of patient rooms on the units. Registered nurses and certified nursing assistants wear badges that track HH upon entry and exit from the room. Appropriate eHH was defined as the use of waterless hand sanitizer or soap within 60 seconds before or after entering or exiting a room. Baseline data was collected for 2 months; a series of interventions, including public recognition of top performers, private individualized feedback, and posters emphasizing social pressures, were undertaken beginning in June 2016 (Figure 1). Descriptive statistics, chi-squared tests, and interrupted time series analyses were used to analyze the data. RESULTS: The median number of total daily observations was 4083 (IQR 3801–4437). The mean eHH adherence rate in the baseline period (Apr/May 2016) was 46% (IQR 44%-49%) and increased to 76% (IQR 75%-78%) in Mar 2017. Over the study period, there was a significant decreasing trend in the proportion of nurses with eHH rates <50% (P < 0.0001, Figure 2) and a significant increasing trend in the proportion of nurses with eHH rates ≥80% on all units (P < 0.0001, Figure 3). CONCLUSION: eHH provides thousands of objective observations per day. eHH rates improved over the study period both due to an increase in nurses with eHH ≥80% and a decrease in the proportion of nurses with eHH <50%. DISCLOSURES: All authors: No reported disclosures.