Assessment Of An Aggregate Electronic Monitoring System To Measure Hand Hygiene In A Hospital Setting

The purpose of this research was to assess the accuracy, acceptance, and impact of a Hand Hygiene Monitoring Technology (HHMT) to measure hand hygiene (HH) in an inpatient hospital setting. First, using a rigorous validation method, a HHMT providing unit-level HH performance was seen to have an overall sensitivity of 88.7% and positive predictive value of 99.2% when tested in a purposeful, controlled environment. When tested for accuracy in detecting behaviors in a real-world inpatient hospital setting, effectiveness of the HHMT was similarly high with overall system sensitivity increasing to 92.7% while PPV was 84.4%. Reduced positive predictive value of the system in capturing room activity was associated with behaviors and workflows that resulted in frequent activity in or near room doorways. Next, using a survey tool rooted in the Theory of Planned Behavior, this study was the first known attempt to conceptualize healthcare personnel acceptance of HHMT using established social cognition theories as the underlying framework. In general, belief in the ability of oneself to contribute to hand hygiene performance as well as participation in collective hand hygiene performance by reminding others to perform HH were the most highly predictive characteristics of reported system usefulness and system use. In order to improve perceived usefulness of the aggregate-level hand hygiene monitoring technology, efforts dedicated towards creating a culture that values hand hygiene not only at an individual level but also as a collective goal may prove beneficial. Finally, Using hand hygiene surveillance data captured 24 hours a day, 7 days a week, every 1% increase in HH was seen to decrease incidence of MRSA in non-colonized patients by 4.4%. Similarly, each 1% increase in HH was seen to decrease incidence of C. difficile by 1.6%. When considering a strict definition of MRSA acquisition as well as incidence of C. difficile acquisition, a 1% increase in hand hygiene performance can save a 600-bed hospital over $126,000 annually among patients at highest risk of acquisition. These findings support continued dedication to improving hand hygiene in the healthcare setting.