Hand hygiene monitoring technology: a systematic review of efficacy.

Electronic and video monitoring systems (EMS/VMS) may improve hand hygiene by providing feedback, real-time reminders or via the Hawthorne effect. The aim of this systematic review was to assess the efficacy of EMS/VMS in improving hand hygiene or reducing the incidence of healthcare-associated infection (HCAI). Experimental and quasi-experimental studies were included if they measured any hand hygiene outcome and/or HCAI incidence. Of the studies included, seven used system-defined compliance (SDC) (N = 6) or hand hygiene event rate (N = 1) as their outcome. SDC differed for all systems. Most (N = 6) were single ward studies. Two uncontrolled pretest‒post-test studies evaluating EMS that provided voice prompts showed increases in SDC, but risk of bias was high. Two uncontrolled time-series analyses of VMS that provided aggregate feedback demonstrated large, sustained improvement in SDC and were at moderate risk of bias. One non-randomized controlled trial of EMS with aggregate feedback found no difference in hand hygiene frequency but was at high risk of bias. Two studies evaluated EMS providing individual feedback and real-time reminders. A pretest‒post-test study at high risk of bias showed an increase in SDC. An RCT at low risk of bias showed 6.8% higher SDC in the intervention arm partially due to a fall in SDC in the control arm. In conclusion, the overall study quality was poor. The study at lowest risk of bias showed only a small increase in SDC. VMS studies at moderate risk of bias showed rapid and sustained increases in SDC. Data were insufficient to recommend EMS/VMS. Future studies should prioritize testing of VMS using stronger study designs including control arms and validated, system-independent measures of hand hygiene.

[1]  V. Hasselblad,et al.  MEDLINE search strategy , 1999 .

[2]  J. Haas,et al.  Measurement of compliance with hand hygiene. , 2007, The Journal of hospital infection.

[3]  J. Popay,et al.  Guidance on the conduct of narrative synthesis in sytematic reviews , 2006 .

[4]  Jennie Popay,et al.  Guidance on the conduct of narrative synthesis in systematic Reviews. A Product from the ESRC Methods Programme. Version 1 , 2006 .

[5]  S. Schröder.  Clean care is safer care. , 2009, South Dakota medicine : the journal of the South Dakota State Medical Association.

[6]  A. Marra,et al.  Controlled Trial Measuring the Effect of a Feedback Intervention on Hand Hygiene Compliance in a Step-Down Unit , 2008, Infection Control & Hospital Epidemiology.

[7]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[8]  M. Muller,et al.  Predictors of hand hygiene compliance in the era of alcohol-based hand rinse. , 2013, The Journal of hospital infection.

[9]  A. Harris,et al.  The use and interpretation of quasi-experimental studies in infectious diseases. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  Philip M Polgreen,et al.  Automated and electronically assisted hand hygiene monitoring systems: a systematic review. , 2014, American journal of infection control.

[11]  A. Marra,et al.  Hand Hygiene: State-of-the-Art Review With Emphasis on New Technologies and Mechanisms of Surveillance , 2012, Current Infectious Disease Reports.

[12]  P. Lipsett,et al.  Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit* , 2004, Critical care medicine.

[13]  A. Detsky,et al.  Public reporting of hospital hand hygiene compliance--helpful or harmful? , 2010, Journal of the American Medical Association (JAMA).

[14]  Sivakumar Viswanathan,et al.  Automated Measures of Hand Hygiene Compliance among Healthcare Workers Using Ultrasound: Validation and a Randomized Controlled Trial , 2013, Infection Control & Hospital Epidemiology.

[15]  E. Perencevich,et al.  Searching for an optimal hand hygiene bundle: a meta-analysis. , 2014, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[17]  D. Armellino,et al.  Replicating changes in hand hygiene in a surgical intensive care unit with remote video auditing and feedback. , 2013, American journal of infection control.

[18]  Arjun K Venkatesh,et al.  Use of electronic alerts to enhance hand hygiene compliance and decrease transmission of vancomycin-resistant Enterococcus in a hematology unit. , 2008, American journal of infection control.

[19]  D. Armellino,et al.  A Randomized Trial of the Efficacy of Hand Disinfection for Prevention of Rhinovirus Infection , 2012, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[21]  M. McGuckin,et al.  Commentary: Electronic Hand Hygiene Compliance Interventions , 2012, American journal of medical quality : the official journal of the American College of Medical Quality.

[22]  Geoff R Fernie,et al.  The Effect of Automated Monitoring and Real-Time Prompting on Nurses’ Hand Hygiene Performance , 2013, Computers, informatics, nursing : CIN.

[23]  Jocelyn A. Srigley,et al.  Hand hygiene monitoring technology: protocol for a systematic review , 2013, Systematic Reviews.

[24]  John M Boyce,et al.  Measuring Healthcare Worker Hand Hygiene Activity: Current Practices and Emerging Technologies , 2011, Infection Control & Hospital Epidemiology.