The impact of automated hand hygiene monitoring with and without complementary improvement strategies on performance rates

Abstract

Objective: To determine how engagement of the hospital and/or vendor with performance improvement strategies combined with an automated hand hygiene monitoring system (AHHMS) influence hand hygiene (HH) performance rates. Design: Prospective, before-and-after, controlled observational study. Setting: The study was conducted in 58 adult and pediatric inpatient units located in 10 hospitals. Methods: HH performance rates were estimated using an AHHMS. Rates were expressed as the number of soap and alcohol-based hand rub portions dispensed divided by the number of room entries and exits. Each hospital self-assigned to one of the following intervention groups: AHHMS alone (control group), AHHMS plus clinician-based vendor support (vendor-only group), AHHMS plus hospital-led unit-based initiatives (hospital-only group), or AHHMS plus clinician-based vendor support and hospital-led unit-based initiatives (vendor-plus-hospital group). Each hospital unit produced 1–2 months of baseline HH performance data immediately after AHHMS installation before implementing initiatives. Results: Hospital units in the vendor-plus-hospital group had a statistically significant increase of at least 46% in HH performance compared with units in the other 3 groups (P ≤ .006). Units in the hospital only group achieved a 1.3% increase in HH performance compared with units that had AHHMS alone (P = .950). Units with AHHMS plus other initiatives each had a larger change in HH performance rates over their baseline than those in the AHHMS-alone group (P < 0.001). Conclusions: AHHMS combined with clinician-based vendor support and hospital-led unit-based initiatives resulted in the greatest improvements in HH performance. These results illustrate the value of a collaborative partnership between the hospital and the AHHMS vendor.

Sample sizes for estimating the sensitivity of a monitoring system that generates repeated binary outcomes with autocorrelation

“…The first step in any time series analysis before fitting an ARMA model is to attempt to model any trend or non-stationarity in the data with linear or polynomial or smoother terms (via general additive models). 22 Afterwards, monitoring system sensitivity is modeled as a logistic function over time, in which case a facility may be interested in estimating the true sensitivity pooled over all time points (by averaging via integration under the logistic curve), or just during times when sensitivity is predicted to be worst. Fitting such models may alleviate the need to fit an ARMA model at all, including the AR(1) model that we consider here.…”

The effect of a prospective intervention program with automated monitoring of hand hygiene performance in long-term and acute-care units at a Veterans Affairs medical center

“…Our overall hand sanitizer to soap ratio of 65% is rather low compared to other hospitals in North America. 28 This may be at least partly due to greater soap use in the LTC units, where soap is still preferred by some HCWs.…”

“…Emerging evidence indicates that effective implementation of an automated hand hygiene monitoring system (AHHMS) must be part of a multimodal hand hygiene (HH) program that includes complementary strategies. [1][2][3] Few published studies have described in detail the intervention strategies used in conjunction with an AHHMS. Although national and international guidelines 4,5 provide valuable resources for training, implementation, and monitoring of HH in healthcare settings, these guidelines do not yet address the effective use of AHHMS.…”

“…1,3,8,9 Additionally, limited evidence suggests that the collaboration of healthcare patient-safety leadership and the AHHMS vendor can contribute to successfully turning HH intervention efforts into a sustained increase in HH compliance in acute-care units. 1,2 However, little published evidence is available on the effectiveness of an AHHMS in long-term care (LTC) units, including nursing homes. 10 The Dayton Veterans Affairs Medical Center (VAMC) includes an 80-bed acute-care hospital, 185-bed LTC facility, and a 91-bed domiciliary.…”