Assessment of an Aggregate-Level Hand Hygiene Monitoring Technology for Measuring Hand Hygiene Performance Among Healthcare Personnel

Abstract

BACKGROUND Despite significant advances in technological methods for hand hygiene surveillance, a lack of evidence prohibits comparison of systems to one another or against the current gold standard of direct observation. OBJECTIVE To validate a hand hygiene monitoring technology (HHMT) designed to capture hand hygiene behaviors aggregated at the hospital-unit level (GOJO Industries, Akron, OH). METHODS Our team followed a rigorous validation approach to assess the sensitivity and positive predictive value (PPV) of an HHMT. A planned path was first used to measure the accuracy of the system when purposefully activated by investigators. Next, behavioral validation was used to quantify accuracy of the system in capturing real-world behaviors. RESULTS During the planned path phase, investigators performed 4,872 unique events across 3 distinct hospital buildings varying in size and age since construction. Overall sensitivity across the medical center was 88.7% with a PPV of 99.2%. During the behavioral validation phase, trained direct observers recorded 5,539 unique events across 3 distinct hospital buildings. Overall sensitivity across the medical center was 92.7% and PPV was 84.4%. CONCLUSION Objective measures of sensitivity and PPV indicate the promise of the benefit of this and other HHMTs to capture basic behaviors associated with hand hygiene. Infect Control Hosp Epidemiol 2017;38:348-352.

The impact of COVID-19 pandemic on hand hygiene performance in hospitals

“…Elements of this system, including the validation process, have previously been described. 11 , 12 Outpatient units, including 2 emergency departments, were excluded from the study. Final analysis included data from 74 adult inpatient units in 7 hospitals (2 Academic, 4 Federal Veterans Administration, and 1 Community) and 10 pediatric inpatient units in 2 children's hospitals (Academic); see data by hospital in Figure 1 .…”

Impact of an automated hand hygiene monitoring system and additional promotional activities on hand hygiene performance rates and healthcare-associated infections

“…Elements of the Smartlink AHHMS have been described in detail. 15 Alcohol-based hand rub (ABHR) and soap dispensers record each dispersal as an HH event (HHE). Activity monitors near each patient room doorway detect each entry into and exit from the room as an HH opportunity (HHO).…”

“…In mid-September 2016, hospital leadership sent 6 frontline nursing staff, the infection preventionist, and the vice president for medical affairs to visit a large hospital in Chicago that had achieved sustained increases in HH compliance rates using the same AHHMS as part of a multimodal strategy. 15,19 Meetings with the physician leading the Chicago hospital's HH campaign included discussions of methods for analyzing AHHMS data and additional promotional activities. Following the visit, administrators approved stepwise installation of the AHHMS on units C and D.…”

“…In addition, the hospital selected a group monitoring system (Smartlink activity monitoring system, GOJO Industries, Akron, OH) with a high degree of sensitivity and positive predictive value. 15 In this article, we describe the impact of combining an AHHMS with multiple promotional activities on HH performance and HAIs.…”

A standardised approach to validate both the accuracy and precision of electronic hand hygiene monitoring systems is needed

“…In another approach to validate an EMS, Limper et al (2017) assessed the accuracy of an EMS manufactured by GOJO Industries. The accuracy of the EMS was established during the behavioural validation phase in a working ward; sensitivity was 92.75% and PPV 84.4%.…”