Program Schedule

Efficacy of Hand Hygiene (HH) Monitoring Technology: a Systematic Review

Session: Poster Abstract Session: Hand Hygiene
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Electronic and video monitoring systems (EMS/VMS) for healthcare worker HH may improve hand hygiene compliance (HHC) by providing feedback (FB) or real-time reminders (RTR). We conducted a systematic review to assess the efficacy of EMS/VMS in improving HHC. Methods: MEDLINE and other databases were searched to 2013. Experimental and quasi-experimental studies of EMS/VMS were included if they measured directly observed HHC (1 outcome), HH frequency, HH product use, or system defined compliance (SDC). Risk of bias (ROB) was assessed using the Cochrane EPOC tool and a scale for quasi-experimental studies. Results: Seven studies were included (Fig 1). Most (6/7) used SDC as their 1 HH outcome; 1 study used HH frequency and 1 used SDC and HH product use. SDC was defined differently for all EMS/VMS. No study measured HH prior to EMS/VMS installation. Most studies were on single wards (6/7) in acute care (6/7). The median (range) of study duration and HH opportunities were 24 weeks (2 to 91) and 194,150 opportunities (8,235 to 1,017,600). Studies are grouped by their mechanism of action: EMS with RTR and no FB: Two pretest-posttest studies evaluated use of voice prompts on room entry and/or exit. Both demonstrated improvement in SDC. Both were at high ROB. EMS/VMS with FB and no RTR: Two studies assessed the same VMS that provided continuous aggregate FB of SDC and found a sustained increase in SDC using a time series design. Both studies were at moderate ROB. One non-randomized controlled study assessed an EMS that provided aggregate FB on HH event rates. There was no difference in HH frequency in the control and intervention unit but baseline HH frequency was not measured and the study was at high ROB. EMS with FB and RTR: Two studies tested EMS that monitored room or zone entry/exit and provided healthcare workers with individual FB and vibratory RTR. A pretest-posttest study showed an increase in SDC but was at high ROB. An RCT showed a small, non-sustained increase in SDC and was at low ROB. Conclusion: No study measured directly observed HHC or HH pre-installation. The only study at low ROB showed no sustained benefit. Before widespread implementation of a complex and expensive technology, efficacy should be demonstrated in well-designed studies at low ROB.

Matthew P. Muller, MD, PhD, FRCPC, University of Toronto, Toronto, ON, Canada; Medicine, St.Michael's Hospital, Toronto, ON, Canada, Jocelyn a. Srigley, MD, MSc, FRCPC, McMaster University, Hamilton, ON, Canada, Gerald Lebovic, PhD, Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada, Geoff Fernie, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada, David Lightfoot, St. Michael's Hospital, Toronto, ON, Canada and Michael Gardam, Toronto General Hospital, University Health Network, Toronto, ON, Canada


M. P. Muller, None

J. A. Srigley, None

G. Lebovic, None

G. Fernie, None

D. Lightfoot, None

M. Gardam, None

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