title: Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit.
abstract: OBJECTIVE
  To determine whether electronic monitoring of hand hygiene and voice prompts can improve hand hygiene and decrease nosocomial infection rates in a surgical intermediate care unit.
  
  
  METHODS
  Three-phase quasi-experimental design. Phase I was electronic monitoring and direct observation; phase II was electronic monitoring and computerized voice prompts for failure to perform hand hygiene on room exit; and phase III was electronic monitoring only.
  
  
  METHODS
  Nine-room, 14-bed intermediate care unit in a university, tertiary-care institution. All patient rooms, utility room, and staff lavatory were monitored electronically.
  
  
  METHODS
  All healthcare personnel including physicians, nurses, nursing support personnel, ancillary staff, all visitors and family members, and any other personnel interacting with patients on the intermediate care unit. All patients with an intermediate care unit length of stay >48 hrs were followed for nosocomial infection.
  
  
  METHODS
  Electronic monitoring during all phases, computerized voice prompts during phase II only.
  
  
  RESULTS
  We evaluated a total of 283,488 electronically monitored entries into a patient room with 251,526 exits for 420 days (10,080 hrs and 3,549 patient days). Compared with phase I, hand hygiene compliance in patient rooms improved 37% during phase II (odds ratio, 1.38; 95% confidence interval, 1.04-1.83) and 41% in phase III (odds ratio, 1.41; 95% confidence interval, 1.07-1.84). When adjusting for patient admissions during each phase, point estimates of nosocomial infections decreased by 22% during phase II and 48% during phase III; when adjusting for patient days, the number of infections decreased by 10% during phase II and 40% during phase III. Although the overall rate of nosocomial infections significantly decreased when combining phases II and III, the association between nosocomial infection and individual phase was not significant.
  
  
  CONCLUSIONS
  Electronic monitoring provided effective ongoing feedback about hand hygiene compliance. During both the voice prompt phase and post-intervention phase, hand hygiene compliance and nosocomial infection rates improved suggesting that ongoing monitoring and feedback had both a short-term and, perhaps, a longer-term effect.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Swoboda
authors.forename: Karen
authors.initials: K
authors.lastname: Earsing
authors.forename: Kevin
authors.initials: K
authors.lastname: Strauss
authors.forename: Stephen
authors.initials: S
authors.lastname: Lane
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lipsett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000517:prevention & control*; D004581:Electronics; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000592:standards*; D006282:Health Personnel; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged