461. Electronic Hand Hygiene Compliance Monitoring Systems: Not All Are Created Equal
Session: Poster Abstract Session: Healthcare Epidemiology: Advances in Hand Hygiene
Thursday, October 4, 2018
Room: S Poster Hall

Background: While direct observation is considered the gold standard for hand hygiene (HH) surveillance, there is a growing interest in the implementation of electronic monitoring systems, which claim to accurately capture individual-level HH performance.

Methods: Two types of electronic hand hygiene monitoring systems (EHHMS) were trialed at an 865-bed, academic medical center over an 18 month period. Each type of EHHMS was piloted in two inpatient units, and hospital employees who had contact with patients and/or the patient environment were eligible to participate. In each trial, participants received standard training and were then asked to wear EHHMS badges while continuing their normal workflow. Methods of assessment included regular review of EHHMS reports, an inter-rater reliability analysis to compare EHHMS to direct observation by trained HH observer, and a qualitative electronic survey to assess the acceptability of EHHMS. HH compliance goal was set at 90%.

Results: In the first pilot, 279 employees volunteered to trial Type A EHHMS for 14 weeks, with an overall HH compliance of 30% (87,688 opportunities). In the second pilot, 169 employees volunteered to trial Type B EHHMS for 12 weeks, with an overall HH compliance of 93% (363,272 opportunities). Voluntary survey response rate for Type A was 32% (90/279) and for Type B was 40% (67/169). The majority of respondents consistently used EHHMS in daily workflow (Type A: 82%, 68/83) (Type B: 82%, 55/67) and most did not felt apprehensive about using the EHHMS (Type A: 19%, 16/83) (Type B: 22%, 15/67).

Inter-rater reliability assessment of piloted EHHMS

Type of Technology


Number of beds

Technology Compliance

HH Observer Compliance

Kappa Statistic

Technology Accuracy

Type A

Unit 1








Unit 2








Type B

Unit 3









Unit 4









Conclusion: Type B EHHMS captured our healthcare workers’ HH performance during clinical workflow with a greater accuracy and more HH events than Type A. EHHMS may provide an alternative method to capture HH compliance in the healthcare setting. Hospitals considering the use of an EHHMS should assess the technology’s ability to accurately capture HH performance in the clinical workflow prior full housewide implementation.



Nadia Masroor, MPH1, Michelle Doll, MD, MPH1, Kaila Cooper, MSN, CIC1, Nital Appelbaum, PhD1, Meagan Rawls, BS1, Allison Fisher, MHA1, Trina Trimmer, MSN1, Michael Stevens, MD, MPH1 and Gonzalo Bearman, MD, MPH, FSHEA2, (1)VCU Medical Center, Richmond, VA, (2)Infectious Diseases, VCU Medical Center, Richmond, VA


N. Masroor, None

M. Doll, None

K. Cooper, None

N. Appelbaum, None

M. Rawls, None

A. Fisher, None

T. Trimmer, None

M. Stevens, None

G. Bearman, None

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