Evaluation Background: Hand Hygiene Compliance Monitoring Systems

August 14, 2019 | Evaluations & Guidance


Here's background for our Evaluations of hand hygiene compliance monitoring systems (HHCMSs), outlining the key considerations for making wise purchasing decisions. Learn how the technology is used, which specs are important, and what factors we test for. Also review our latest product ratings and ECRI Institute's data describing hospitals' interest in each vendor.

The primary purpose of an HHCMS is to automatically monitor hand hygiene compliance rates—that is, the number of hand hygiene events (i.e., activation of or proximity to a hand soap or sanitizer dispenser) divided by the number of hand hygiene opportunities (i.e., times when an individual should clean their hands, such as when entering a patient's room) or similar compliance metric.

Defining characteristics of HHCMSs include:

  1. A means of measuring hand hygiene events

  2. A means of collecting or estimating hand hygiene opportunities

  3. Availability of reports for viewing hand hygiene compliance information calculated from event and opportunity data

HHCMSs are not classified by FDA. The technology is new and has undergone many changes in systems and manufacturers in recent years. Manufacturers continue to add advanced features that may help with the following: system customization to meet facility needs (configurable care areas, alert types, report type and report e-mail frequency, etc.); system and web portal ease of use; data analysis services; integration with a facility's existing hand soap and alcohol sanitizer products and/or dispensers; identification of patient isolation rooms for active or suspected infections; reducing or eliminating user-required maintenance; and battery management and recycling.

HHCMSs can be broadly categorized as group-level or individual-level. Group-level HHCMSs use monitored dispensers to count hand hygiene events and either care area sensors or proprietary algorithms to assess hand hygiene opportunities. Group-level HHCMSs provide aggregate hand hygiene compliance rates of staff, outside vendors, caregivers, visitors, and patients that used monitored dispensers within a care area during a certain time period (i.e., hour, day, week, or month).

Individual-level HHCMSs have the capabilities of group-level HHCMSs, plus the ability to track the hand hygiene compliance of individuals wearing system tags (i.e., badges, badge holders, bracelets). Monitored dispensers or chemical sensors within the badges count hand hygiene events, and a network of sensors within a care area measures hand hygiene opportunities of tagged users. Some of these systems provide real-time alerting at the point of care regarding tagged users' hand hygiene compliance. A web portal allows certain users to view hand hygiene compliance rates for tagged individuals (e.g., staff, outside vendors, caregivers, visitors, and patients) during a specified time period per individual, unit, or across entire facilities.

Individual-level HHCMSs can be further divided into two categories: systems that continuously track staff (and sometimes patient) location, and systems that do not. Real-time locating systems (RTLSs) are a multipurpose technology that can be used to locate and track tagged users, equipment, patients, or other items of interest in near real time within an area defined by the system configuration. This location information is collected by hardware installed within the facility, aggregated, and presented to end users through a web portal. Hand hygiene compliance is identified through applying rules to both clinician location and dispenser sensor information. For example, a nurse may be considered noncompliant if they enter a patient room and approach the patient's bed without performing hand hygiene, but a nurse that enters a patient room and utilizes the hand soap or sanitizer dispenser on their way to the patient bed is considered compliant. Hand hygiene compliance is just one application of an RTLS; most facilities considering an RTLS-based HHCMS will also be looking to utilize the RTLS for other purposes like equipment or nurse tracking. Adoption of this technology requires clinicians to consent to continuous monitoring of...

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