An Evaluation of the use of a Video System to Improve the Quality of Hand Hygiene Practice

Background: Education and audits with feedback are strategies to improve hand hygiene compliance, but little is known of the effectiveness of these in reducing hand contamination among healthcare workers (HCWs). Furthermore audit of hand hygiene practice is mainly related to frequency and less to the quality and technique of hand hygiene.

Objective: To evaluate the use of video equipment as an educational aid in monitoring six poses associated with correct hand hygiene practice, and providing feedback (colour change of lights to indicate correct practice) to HCWs during 3 phases; phase one, no feedback (no ‘lights’ as baseline practice), phase two (‘lights’ as feedback) and phase three (no ‘lights’ to assess sustained improvement in practice after feedback).

Methods: A video system, (Surewash, Kinometrics, US), was designed with a visual interface, showing 6 timed poses, comprising 10 separate poses that accounted for left and right hands,  associated with correct hand hygiene procedure. For each pose, a ‘light’ changed colour on successful completion of the pose. When completed, a readout on the interface, showed either a ‘pass’ or ‘fail’, including the total time taken.  Following piloting, the video system, installed on a mobile stand with an alcohol gel dispenser, was situated on one ward corridor to run for the 3 phases.

Results: 55 HCWs voluntarily used the system with 25 (45%) successfully completing the session, 13/29 (13%) phase one, 8/21 (38%) phase two and 4/5 (70%) phase 3. Of the 10 poses completed, the average was 935/1100 (85%), range 68%-98%, with the last five poses missed more frequently, 142/550 (26%) than the first, 62/550 (11%), p=<0.00001. The average time taken to complete sessions was 50 seconds, phase one, 38 seconds, phase two and 53 seconds, phase three.

Conclusions: While the completion rate, 45%, was low, HCWs scored significantly higher on individual poses at the beginning of the session, indicating, perhaps, greater concentration at the start of hand hygiene. The HCW participation rate was low, possibly related to accessibility to the system, i.e.  on a corridor, or there may be less incentive for HCWs to use the system when there is no feedback, as during phase three. Improvements in the design, accessibility and availability of systems may encourage HCWs to use video systems as educational aids, to improve the quality of hand hygiene.