Obstacles to the successful introduction of an electronic hand hygiene monitoring system, a cohort observational study

Abstract

Background: Hand hygiene (HH) compliance remains low in many intensive care units (ICU). Technology has been suggested to improve HH compliance. We describe the introduction of an electronic HH surveillance and intervention system into the general ICU of a tertiary care teaching hospital, the obstacles to success and reasons for the system's ultimate failure and removal. Methods: The system was based on radiofrequency transmitters in patient areas, on HH dispensers, and individual personal bracelets. The transmitters were connected to a central computer. The system was designed to detect entry and exit from patient areas and provide real time alerts of missed HH performance. A staff satisfaction questionnaire was administered followed by validation of system accuracy. Electronic data were compared to human observer data collected during defined observation periods. Results: Data from 41 questionnaires revealed low satisfaction rate (21/41, 51%). Low system accuracy (31/41, 76%) and inconvenience (18/41, 44%) being the most frequent reasons. During 44 one hour observation periods the observer recorded more HH opportunities and performances than the electronic system (mean number of HH opportunities/hour 10.9 ± 7.6 vs 6.8 ± 6.9, p < 0.001, correlation r = 0.75, p < 0.001, and performances/hour 8.7 ± 3.9 vs 6.0 ± 3.1, p < 0.001, correlation r = 0.60, p < 0.001, respectively). Correlation between observer and HH electronic system was very low (correlation coefficient r = 0.03, p = 0.91). Conclusions: The electronic HH system was not accepted by ICU staff principally due to inaccuracy and inconvenience. Inaccuracies were verified by direct observations. In order for an electronic HH system to succeed we suggest it must be highly accurate and comfortable to use.