Successful Utilization of Alcohol Sensor Technology to Monitor and Report Hand Hygiene Compliance

Background: Although hand hygiene (HH) remains the most important intervention to reduce healthcare associated infections, compliance by healthcare workers (HCWs) remains suboptimal and no interventions have been found to produce sustained, high levels of compliance.

Objective: To assess the efficacy of alcohol sensor technology on improving HH compliance.

Methods: Hand hygiene compliance was determined by a trained nurse-observer over a 4-week period (100 hours total observation time) in a 35-bed inpatient ward at an 820-bed, urban, academic medical center. Three weeks later, 18 nurses on the same unit were assigned to wear alcohol sensor badges (BioVigil LLC, Santa Rosa, CA) for a two-week period. The badges are activated at the doorway and alert the HCW with light and sound upon entry and exit. If alcohol is detected within 8 seconds of room entry a positive recording is made and the badge light turns green. If alcohol is not detected, a negative reading is recorded and the badge light turns red. The compliance data for each badge is instantaneously transmitted via wireless telemetry to a centralized database; however for the purpose of the study no feedback on performance was given to nurses. HH compliance was compared between the two time periods.

Results: In the pre-intervention control phase (1,070 visual observations), HH compliance among nurses was 73%. In the intervention phase (6,318 electronic observations by continuous monitoring), HH compliance was 92% (p<0.0001), and individual compliance ranged from 72% to 100% with a median compliance of 93%. 44% of nurses had compliance rates ≥95%. Compliance on room entry was 90% and on room exit 94%. There was <2% difference in compliance rates between work shifts (7am-3pm, 3-11pm, 11pm-7am). Using the alcohol sensor badges, we determined that there are 10.5 HH opportunities per nurse-hour.

Conclusions: Our study demonstrated easy adoption of an alcohol sensing badge in the clinical setting, with a rapid and significant improvement in HH compliance to very high levels. Nearly half of nurses achieved ≥95% compliance. Moreover, if this technology were coupled with performance feedback by supervisors and patients were instructed to observe the color of the badge light before contact with the HCW, it seems likely that HH compliance could be driven to essentially perfect performance levels. Lastly, we demonstrated that the number of HH opportunities for nurses when formally measured is vast.