Use of Electronic Devices to Detect Changes in Hand Hygiene Frequency During the Early H1N1 Influenza Outbreak and During a Trial of a New Alcohol Hand Sanitizer Formulation

Background: Measuring hand hygiene (HH) product usage can be used to monitor trends in the frequency of HH among healthcare workers (HCWs). 

Objective: Utilize prototype wireless electronic devices placed in alcohol hand sanitizer dispensers to determine if changes in HH frequency occurred during a trial of a new alcohol hand sanitizer formulation.

Methods: Alcohol hand sanitizer dispensers located in a surgical intensive care unit (SICU) and a general medical ward (GMW) have been equipped with prototype wireless electronic devices since April 2009. Devices detected each time a dispenser was accessed, defined as a HH event (HHE) for the purposes of this study.  HH frequency was expressed as the number of HHE/patient-day (pt-d).  A new alcohol hand sanitizer formulation with different esthetics was placed in all dispensers in the two study units for a period of ~5 weeks (late July through early September) to determine the level of acceptance of the product by nursing staff. Nurses completed pre-trial and post-trial questionnaires regarding their attitudes about the traditional and test sanitizers. Unit-specific HH frequency rates for the baseline period (April-July) were compared to rates during the product trial by using Mann Whitney tests.

Results: During late April and early May, when media coverage of the newly discovered 2009 H1N1 pandemic was intense, HH frequency rates increased substantially in both the SICU and on the GMW for several weeks, and then decreased and remained stable for several months.  In late July and August, when the trial of the new sanitizer formulation was occurring, the median HH frequency rate in the SICU  (36.1/pt-d) was significantly lower than during the baseline period (41.7/pt-d) (p = 0.01). In contrast, the median HH frequency rate on the GMW during the trial (12.4/pt-d) was not significantly different from the baseline rate (14.2/pt-d) (p = 0.14).  A greater proportion of nurses on both units preferred the traditional sanitizer to the test product. Factors that may explain in part the different results obtained for the two units during the trial period include the greater frequency of sanitizer use in the SICU during the trial (median, 36.1 HHE/pt-d) when compared to the GMW (median, 12.4 HHE/pt-d) (p = 0.004) and a difference between the SICU and the GMW in the proportion of nurses employed more than 10 years [24 (42%) of 57 in the SICU and 5 (12%) of 42 in the GMW, p = 0.001] Conclusions:   Wireless electronic devices located inside alcohol hand sanitizer dispensers detected a temporary increase in HH frequency coincident with the early weeks of the H1N1 pandemic, and a significant drop in HH frequency rate in the SICU during a trial of a new hand sanitizer formulation.  Electronic devices for measuring the frequency of alcohol hand sanitizer use can detect changes in hand hygiene practices over time.