Gratuitous Hand Hygiene Post: Automated Surveillance Technology

Today, May 5th, is Hand Hygiene Day. If you're looking for links to hand hygiene campaign material, the CDC page is a great place to start. Instead of the usual hand hygiene video or bundle of interventions, I wanted to highlight a recent study our group completed that was just published in AJIC.

The study was led by Melissa Ward, one of Loreen Herwaldt's star research coordinators.  Melissa, spent many months scouring the medical literature for evidence that automated hand hygiene surveillance systems are accurate, effective and cost-effective. After an initial 3,463 article abstracts were identified, she painstakingly reviewed each one to find 42 articles that were original science and evaluated at least one aspect of at least one surveillance technology.  Four types of systems were identified: electronically assisted/enhanced direct observation, video-monitored direct observation, electronic dispenser counters, or automated hand hygiene monitoring systems.

To save you some time, here are the main conclusions from the study: Few articles assessed the accuracy of these electronic monitoring systems and those that did reported "little to no hand hygiene compliance rate differences between direct observation and automated or electronically assisted systems, including electronically enhanced direct observation." However, two studies found differences favoring the automated approach, so we concluded that "more research should be done to validate the accuracy of these systems."

Most importantly there was little evidence that "these systems can improve hand hygiene compliance" and there is currently "limited evidence to recommend the adoption of one type of system or approach as no high-quality quasiexperimental studies, cluster-randomized trials or decision-analytic modeling studies have been completed or published that would allow the comparative effectiveness of system types or individual systems to be assessed."

So what is my gratuitous (second definition: "free") advice: "Facilities should pilot test systems compared to gold-standard, directly observed compliance surveillance before they are widely implemented."