title: Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology.
abstract: BACKGROUND
  MedSense is an electronic hand hygiene compliance monitoring system that provides Infection Control Practitioners with continuous access to hand hygiene compliance information by monitoring Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" guidelines. Unlike previous electronic monitoring systems, MedSense operates in open cubicles with multiple beds and does not disrupt existing workflows.
  
  
  METHODS
  This study was conducted in a 6-bed neurosurgical intensive care unit with technical development and evaluation phases. Healthcare workers (HCWs) wore an electronic device in the style of an identity badge to detect hand hygiene opportunities and compliance. We compared the compliance determined by the system and an infection control nurse. At the same time, the system assessed compliance by time of day, day of week, work shift, professional category of HCWs, and individual subject, while the workload of HCWs was monitored by measuring the amount of time they spent in patient zones.
  
  
  RESULTS
  During the three-month evaluation phase, the system identified 13,694 hand hygiene opportunities from 17 nurses, 3 physiotherapists, and 1 healthcare assistant, resulting in an overall compliance of 35.1% for the unit. The per-indication compliance for Moment 1, 4, and simultaneous 1 and 4 were 21.3% (95%CI: 19.0, 23.6), 39.6% (95%CI: 37.3, 41.9), and 49.2% (95%CI: 46.6, 51.8), respectively, and were all statistically significantly different (p < 0.001). In the four 20-minute sessions when hand hygiene was monitored concurrently by the system and infection control nurse, the compliance were 88.9% and 95.6% respectively (p = 0.34), and the activity indices were 11.1 and 12.9 opportunities per hour, respectively. The hours from 12:00 to 14:00 had a notably lower compliance (21.3%, 95%CI: 17.2, 25.3) than nearly three quarters of the other periods of the day (p < 0.001). Nurses who used shared badges had significantly (p < 0.01) lower compliance (23.7%, 95%CI: 17.8, 29.6) than both the registered nurses (36.1%, 95%CI: 34.2, 37.9) and nursing officers (34.0%, 95%CI: 31.1, 36.9) who used named badges.
  
  
  CONCLUSIONS
  MedSense provides an unobtrusive and objective measurement of hand hygiene compliance. The information is important for staff training by the infection control team and allocation of manpower by hospital administration.
authors: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors: Vincent C C
authors: VC
authors: Cheng
authors: Josepha W M
authors: JW
authors: Tai
authors: Sara K Y
authors: SK
authors: Ho
authors: Jasper F W
authors: JF
authors: Chan
authors: Kwan Ngai
authors: KN
authors: Hung
authors: Pak Leung
authors: PL
authors: Ho
authors: Kwok Yung
authors: KY
authors: Yuen
references: Lancet Infect Dis. 2006 Oct;6(10):641-52
references: 17008173
references: Infect Control Hosp Epidemiol. 2009 Nov;30(11):1090-5
references: 19775238
references: Infect Control Hosp Epidemiol. 2011 Mar;32(3):229-37
references: 21460507
references: J Hosp Infect. 2007 Dec;67(4):336-43
references: 18022285
references: Ann Intern Med. 2004 Jul 6;141(1):1-8
references: 15238364
references: J Hosp Infect. 2010 Mar;74(3):271-7
references: 20061056
references: Am J Infect Control. 2008 Apr;36(3):199-205
references: 18371516
references: Infect Control Hosp Epidemiol. 2009 Jul;30(7):611-22
references: 19508124
references: Infect Control Hosp Epidemiol. 2008 Aug;29(8):730-5
references: 18631114
references: Arch Intern Med. 2002 May 13;162(9):1037-43
references: 11996615
references: Emerg Infect Dis. 2001 Mar-Apr;7(2):174-7
references: 11294700
references: J Hosp Infect. 2007 May;66(1):34-9
references: 17434238
references: Crit Care Med. 2004 Feb;32(2):358-63
references: 14758148
references: J Hosp Infect. 2001 Mar;47(3):198-209
references: 11247680
references: Infect Control Hosp Epidemiol. 2010 Dec;31(12):1294-7
references: 20973724
references: J Hosp Infect. 2010 Dec;76(4):364-5
references: 20869135
references: Am J Epidemiol. 1985 Feb;121(2):182-205
references: 4014115
references: Infect Control Hosp Epidemiol. 2010 Jun;31(6):634-9
references: 20426579
references: Anesthesiology. 2003 Sep;99(3):530-5
references: 12960535
references: BMC Infect Dis. 2010 Sep 07;10:263
references: 20822509
references: J Hosp Infect. 2009 Aug;72(4):370-1
references: 19592137
references: Lancet. 2000 Oct 14;356(9238):1307-12
references: 11073019
references: Infect Control Hosp Epidemiol. 2006 Sep;27(9):931-4
references: 16941318
references: AMIA Annu Symp Proc. 2009 Nov 14;2009:662-6
references: 20351937
references: J Hosp Infect. 2008 Nov;70(3):216-22
references: 18799234