Strong Hand Hygiene Culture Trumps Monitoring Devices

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Hand hygiene has been on everybody’s mind since the advent of coronavirus disease 2019 (COVID-19), but the raising of public consciousness unveiled the embarrassing fact that proper hand hygiene at hospitals and other healthcare facilities has been low for decades. What to do? Well, as with so much else that needs fixing in society, perhaps technology can provide the answer. Enter electronic hand hygiene monitoring systems (EHHMS). The systems can range from the simple (having soap dispensers record each time they are activated), to the more complex that involve giving healthcare workers badges or wristbands that sense if a healthcare worker has entered a patient area and, if so, if they used proper hand hygiene.

This communication can occur using different methods: radio-frequency identification,ultrasound, infrared, Wi-Fi, remote video monitoring, or alcohol vapor sensing systems.

Whether simple or complex, EHHMS seem to have one thing in common, according to a study in the American Journal of Infection Control. They don’t work. Or, if they do work, they won’t continue to work for an extended period unless they exist within a healthcare culture that makes proper hand hygiene a priority. Whether such a culture needs to use EHHMS at all remains an open question, according to investigators with Widener University.

They cited “consistent and constant messaging and staff empowerment as key drivers of success, and noted empowering and inspiring staff to be crucial components for realizing the full benefits of an EHHMS.” One facility reported “great success with traditional hand hygiene monitoring techniques, using patient surveys and direct observation through an intradepartmental infection control team, and attributed their high rates of hand hygiene compliance to their robust hand hygiene culture.”

The data were gathered through surveys and interviews at 56 acute care hospitals in New York State. The investigators wanted to evaluate the impact EHHMS had on Clostridium difficile infection (HA-CDI) rates. Only 2 of the 56 hospitals had actually installed the systems, and only one of those hospitals shared their experience.

Many of the hospitals in the study were rural, nonacademic hospitals with fewer annual discharges. That may account for the lack of EHHMS, the study notes. “Overwhelmingly, facilities indicated the initial investment of money and staff resources required to implement an EHHMS to be the main reason hospitals have declined this intervention,” the study states.

And there is some benefit to EHHMS. Investigators write that the hospital with the EHHMS found that it “vastly improved data collection and was effective at improving hand hygiene compliance rates, at least in the short-term, serving as a catalyst for renewed attention on hand hygiene.”

However, officials at that hospital also stressed that EHHMS is no substitute for a strong hand hygiene culture. The improved hand hygiene rates can “easily be dismantled through staff turnover. The trend analysis supported this experience, revealing a sharp decline in HA-CDI rates following implementation, which persisted for approximately 12 months before regressing,” the study states.

It should be noted that “the trend analysis for the hospital with an EHHMS that declined to share their experience showed limited impact on HA-CDI rates pre- and postimplementation of the system.”

The study concludes that “adoption of EHHMS appears to be low in acute care facilities in New York State and hospitals with these systems are experiencing mixed results regarding improved hand hygiene compliance and number of related HAIs…. Strong organizational culture in support of hand hygiene was emphasized by multiple facilities as essential to attaining high rates of compliance. It seems an EHHMS could be a powerful tool for igniting that culture, though hospital staff needs to be diligent in their efforts to maintain the initial enthusiasm.”