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Randomized Controlled Trial
. 2020 Dec 17;71(10):e680-e685.
doi: 10.1093/cid/ciaa412.

Introduction of Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study

Jerome A Leis  1   2   3   4 , Jeff E Powis  3   4   5 , Allison McGeer  3   6 , Daniel R Ricciuto  7 , Tanya Agnihotri  1 , Natalie Coyle  1 , Victoria Williams  1 , Christine Moore  6 , Natasha Salt  1 , Louis Wong  6 , Liz McCreight  6 , Sajeetha Sivaramakrishna  5 , Shara Junaid  8 , Xinghan Cao  2 , Matthew Muller  3   8
Affiliations
Randomized Controlled Trial

Introduction of Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study

Jerome A Leis et al. Clin Infect Dis. .

Abstract

Background: The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Group electronic monitoring is a validated method of measuring HH adherence, but data demonstrating the clinical impact of this technology are lacking.

Methods: A stepped-wedge cluster randomized quality improvement study was performed on 26 inpatient medical and surgical units across 5 acute care hospitals in Ontario, Canada. The intervention involved daily HH reporting as measured by group electronic monitoring to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (percentage) between baseline and intervention. Secondary outcomes included transmission of antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections.

Results: After adjusting for the correlation within inpatient units and hospitals, there was a significant overall improvement in HH adherence associated with the intervention (incidence rate ratio [IRR], 1.73 [95% confidence interval {CI}, 1.47-1.99]; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1 395 450/4 544 144) to 37% (598 035/1 536 643) within 1 month, followed by consecutive incremental increases up to 53% (804 108/1 515 537) by 10 months (P < .0001). There was a trend toward reduced healthcare-associated transmission of MRSA (IRR, 0.74 [95% CI, .53-1.04]; P = .08).

Conclusions: The introduction of a system for group electronic monitoring led to rapid, significant improvements in HH performance within a 2-year period. This method offers significant advantages over direct observation for measurement and improvement of HH.

Keywords: electronic monitoring; hand hygiene; healthcare-associated infection; nosocomial infection; quality improvement.

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