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. 2022 Sep 29;2(1):e161.
doi: 10.1017/ash.2022.303. eCollection 2022.

Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit

Eduardo Casaroto  1 , Jose R Generoso Jr  1 , Ary Serpa Neto  1   2 , Marcelo Prado  3 , Guilherme M Gagliardi  3 , Fernando Gatti de Menezes  1 , Priscila Gonçalves  1 , Fábio Barlem Hohmann  1 , Guilherme Benfatti Olivato  1 , Gustavo Potratz Gonçalves  1 , Nathalia Xavier  1 , Marcelo Fernandes Miguel  1 , Michael B Edmond  4 , Alexandre R Marra  1   5   6
Affiliations

Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit

Eduardo Casaroto et al. Antimicrob Steward Healthc Epidemiol. .

Abstract

Objective: We sought to determine whether an electronic hand hygiene (HH) system could monitor HH compliance at similar rates to direct human observation.

Methods: This 4-year proof-of-concept study was conducted in an intensive care unit (ICU) of a private tertiary-care hospital in São Paulo, Brazil, where electronic HH systems were installed in 2 rooms. HH compliance was reported respectively using direct observation and electronic counter devices with an infrared system for detecting HH opportunities.

Results: In phase 1, HH compliance by human observers was 56.3% (564 of 1,001 opportunities), while HH compliance detected by the electronic observer was 51.0% (515 of 1,010 opportunities). In phase 2, human observers registered 484 HH opportunities with a HH compliance rate of 64.7% (313 of 484) versus 70.6% (346 of 490) simultaneously detected by the electronic system. In addition, an enhanced HH electronic system monitored activity 24 hours per day and HH compliance without the presence of a human observer was 40.3% (10,642 of 26,421 opportunities), providing evidence for the Hawthorne effect.

Conclusions: The electronic HH monitoring system had good correlation with human HH observation, but compliance was remarkably lower when human observers were not present due to the Hawthorne effect (25%-30% absolute difference). Electronic monitoring systems can replace direct observation and can markedly reduce the Hawthorne effect.

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Figures

Fig. 1.
Fig. 1.
Infrared system installed inside the room: (1) bedside sensor, (2) alcohol-based handrub dispenser, (3) infrared camera, (4) monitor, (5) room entrance and exit, and (6) infusion pump. The grey area represents the area captured by the infrared camera.
Fig. 2.
Fig. 2.
Room photo showing some items depicted in Figure 1: (1) bedside sensor, (2) alcohol-based handrub dispenser, (3) infrared camera, (4) monitor, (5) room entrance and exit.
Fig. 3.
Fig. 3.
Process used to identify physical contact events using machine learning image segmentation (phase 2).
See this image and copyright information in PMC

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