Utility of an Electronic Monitoring and Reminder System for Enhancing Hand Hygiene Practices in a Pediatric Oncology Unit

Background: Healthcare-associated infections (HAI) are associated with substantial morbidity, mortality, and emergence of antimicrobial resistance among hospital pathogens.  Improving hand hygiene (HH) adherence among healthcare workers (HCW) remains a key strategy for reducing HAI rates.  Major stakeholders (CDC, WHO, The Joint Commission) have postulated that improving HCW HH adherence could reduce HAIs by 50%.  Current methods (direct observation, product utilization, or subjective reporting of HH activities) for ascertaining HH adherence are fraught with bias and unreliability.   Thus, we evaluated the utility of a new HH monitoring and reminder system designed to accurately monitor HH adherence, provide the same intensity of surveillance for all shifts, and document failure to perform HH before each patient encounter.

Objective: To determine the utility of an electronic monitoring system in ascertaining and enhancing HH adherence among HCWs entering the proximity of patient care areas in a pediatric oncology unit

Methods: The monitoring system includes a bed monitor which establishes a seven foot safe radius infrared/acoustic field around a patient bed, an electronic badge for HCWs, and a hand wash station (HWS) that can monitor HH.  Data from monitors, badges, and HWS are transmitted to a database.  HH was performed with soap containing 4% isopropyl alcohol or a 62% ethanol gel.  The system was installed in a 30-bed pediatric oncology unit at a stand-alone, pediatric facility in South Florida.

Results: During September 3^rd – October 10, 2010 (study period), 79 HCWs participated,  representing 6315 HWS interactions, 6888 monitor interactions, and 9,759 true badge log-in events.  There was 100% correlation between badge and monitors and 100% correlation between the badge and HWS.  The mean daily compliance to HH among physicians (436 hand washing events) and nurses (7,834 hand washing events), was similar at 94%, respectively.  All data were accurately transmitted to the database; the system detected all attempts to approach a monitor or bed without conducting HH and appropriately warned the respective HCW to perform HH.

Conclusions: The electronic system performed with 100% accuracy during a five-week study period,  provided monitoring at the same intensity for all shifts in a busy pediatric oncology unit, and maintained HH compliance among physicians and nurses consistently above 90%.  Communications between the badge, monitor, HWS, and database were exceptionally reliable.  HCWs entering the proximity of a patient bed without performing HH were reminded to do so 100% of the time.  These results suggest that electronic monitoring of HH among HCWs has an important role to play in current and future endeavors to reduce HAI in US healthcare facilities.