Electronic monitoring may offer a more realistic measure than human observation when evaluating hand hygiene, a real-world comparison

Reviewed by Cindy Noyes, MD, University of Vermont Medical Center, Burlington, VT

Casaroto and colleagues compared hand hygiene compliance via electronic monitoring in contrast to human observation in a Brazilian intensive care unit. The electronic hand hygiene devices were installed in 2 rooms in the ICU. Dispensers measured quantity of alcohol-based rub dispensed and were equipped with a badge monitor that identified opportunities for hand hygiene and reinforced when hand hygiene was completed. A ceiling camera with infra-red sensor to assess mobility within the room was present.  Consistent, trained human observers whose identity was concealed from staff performed the direct observations. When performed concordantly, there was excellent agreement between electronic monitoring and human observations. However, in the absence of the human observer, electronic monitoring suggested far fewer opportunities were being availed. The investigators suggested that electronic monitoring may have less of a Hawthorne effect and be a more realistic measure of hand hygiene performance. 

Reference: Casaroto E, et al (2022).  Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit.  Antimicrobial Stewardship and Healthcare Epidemiology. https://doi.10.1017.ash.2022.303

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