Building and Testing a Device to Monitor and Improve Hand Hygiene Compliance in Hospital Care

Hand hygiene (HH) is an essential component of hospital care, however, it is not universally practiced by health care workers (HCWs). High-tech solutions exist for monitoring HH, but are not widely used due to high cost and other limitations. The aims of this study were to build and test a system to monitor and remind HCWs and visitors to perform HH before and after patient contact. We designed a HH monitoring system using widely available electronic circuit parts, and tested it in the neuroscience intensive care unit of Zale Lipshy University Hospital. Our device consisted of three motion sensors, one placed on the hand sanitizer dispenser inside the patient room, one placed on the dispenser outside the room, and one on the door. The three sensors were configured to detect if entrance into or exit from a patient's room was immediately preceded by use of the local dispenser. The device also used an audiovisual reminder when a subject failed to initially hand sanitize. A cloud-based method was used to transmit and record data from the devices over the Internet onto online Excel spreadsheets based on whether the person entering or exiting the patient room was compliant or non-compliant in HH. Compliance was defined as subjects hand sanitizing either immediately before entering or exiting the patient room or within the set time period that the reminder was given. Device functionality was tested via a direct observational period, after which observational data were compared with data recorded by the device. Our device was able to monitor and record HH compliance in a high percentage of HCWs and visitors. Out of 100 observations, 73 were recorded by the device as compliant and 27 as non-compliant. Of the 73 compliant cases, 2 were actually non-compliant; of the 27 non-compliant cases, 5 were actually compliant. Sensitivity was 93% and specificity was 92%. The device was able to differentiate compliant from non-compliant subjects entering or exiting the patient room, initiate a reminder, and automatically record the data. Our study shows that HH compliance in hospital care can be monitored with a low cost, easy-to-build electronic device that overcomes several limitations posed by existing solutions. Future studies will continue to look at the long-term effect of an audiovisual reminder on increasing HH compliance in hospital care.