Impact of introducing group e-monitoring on hand hygiene adherence and MRSA acquisition at an acute care teaching hospital

Background:  The gold standard for hand hygiene adherence (HHA)measurement is observational audit (oaHHA), despite several studies documenting substantial and variable Hawthorne effects. Group e-monitoring (GEM) systems count dispenses of alcohol handrub/soap on units, and use patient census, nurse-patient ratio and studies of HHO to provide 24/7 HHA data. Data supporting their effect on HHA and on reducing healthcare associated infections are limited. We report the results of pilot studies of GEM of HHA in our hospital.

Methods:  To complement our current multi-faceted hand hygiene program, we introduced the DebMed GMS system to 3 of 11 medical/surgical inpatient units in our hospital for 3mos in 2014. In June 2015, the system was reintroduced to the 3 units and to 4 additional in-pt units.  We report data on HHA by observational audit and by e-monitoring, and rates of MRSA acquisition and days of additional precautions for MRSA.

Results:  GEM data prior to pilot launch demonstrated estimated actual 24/7 HHA (eHHA) of 21,21, and 39% on 3 units. Over the 3m pilot, eHHA increased by 9%; over the next 12 months ( data were no longer reported), HHA on these units declined to baseline.  After re-introduction of the system in 7/2015, eHHA increased more slowly; the overall rate of eHHA on monitored wards increased from 27.0% in Q3 2015 to 32.9% in Q1 2016. Increases in eHHA from Q1 - Q3 of implementation ranged from 1.9% to 12.3% on different units (Figure 1).  Comparing rates in the 2 yrs prior to introduction in June 2015 and those of the most recent 6 mos, episodes of MRSA acquisition trended down from >3.0 to 0.20 /1000ptdys (Figure 2: P=0.5), and pt-days in MRSA precautions decreased from 15.8 to 12.8 /1000ptdys (Figure 3, P<.001).

Conclusion:  Use of GEM significantly improved HHA in our hospital. Even small overall increases in HHA may be associated with clinically significant reductions in MRSA transmission.