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    Abstract Title: Trial of Hand Hygiene Monitoring System with Immediate Feedback
    Topic: Infection prevention in acute and specialist settings
    Authors: 
    Sarah Storey1, Ginny Moore1, Graham Fitzgerald1, Ellie Knights1, Sarah Atkinson2, Alaric Best3
    1UCLH NHS Foundation Trust,  2Nottingham University , 3Veraz Ltd

    Abstract Text: 

    Trial of a Hand Hygiene Monitoring System with Immediate Feedback

    INTRODUCTION

    Hand hygiene is central to the campaign to reduce hospital-acquired infection and encouraging compliance is the main focus of infection control within hospitals.

    Targets for compliance are high (>90%) and results are publicised. However, observations are not made out of hours or when not under direct vision and require significant staff resources.  

    A wireless monitoring system has been developed that can detect direct contact between healthcare worker and patient and/or any tagged item of equipment or furniture. It can also detect any subsequent use of alcohol gel and/or soap and water. Information is relayed via a badge worn by staff. A green light indicates recent hand hygiene, amber, inactivity and a red light a need for hand hygiene or a breach in hand hygiene compliance.

    The aim of this study was to determine if real time feedback would improve the rate of hand hygiene. Staff acceptability and patient empowerment were also important outcomes.

    METHODS

    The monitoring system was installed within three wards.  Each bed space (n = 55) was electronically zoned and every patient bed, table and chair tagged.

    The study ran 7 days a week (10 am – 4 pm) for 5 weeks and comprised 3 key phases: automatic monitoring with the badge only showing a green light (inactive phase); monitoring with the badge changing colour (active/feedback phase) and monitoring with the badge set again at green (inactive phase). Visual audits were also conducted.  No individualised patient or staff data was obtained. A hand wash over 45 seconds or hand gel use were counted as evidence of hand hygiene.

    A questionnaire was completed by both patients and staff.  Patient questionnaires were administered by a research nurse and a patient representative.

    RESULTS AND DISCUSSION

    14 staff participants were monitored. In the first inactive phase, there were 1665 first contacts. Hand hygiene compliance was recorded at 21.62%. During the active phase, there were 3672 first contacts and hand hygiene compliance was 66.05%. In the final inactive phase, there were 1369 first contacts with 62.17% compliance. The contemporaneous visual audits indicated median compliance of 43% (11-75% n=38), 58% (40-87% n=9) and 64% (18-100% n=16). Although patients thought the system would improve hand hygiene some did not want to challenge staff and others ignored the badge. 

    Automatic monitoring of hand hygiene with immediate feedback appears an effective means of improving hand hygiene compliance.