title: Automated measures of hand hygiene compliance among healthcare workers using ultrasound: validation and a randomized controlled trial.
abstract: OBJECTIVE
  The primary objective of this study was to validate a novel method of assessing hand hygiene compliance using ultrasound transmitters in patient zones and staff tagged with receivers. The secondary objective was to assess the impact of audio reminders and quantified individual feedback.
  
  
  METHODS
  An observational comparison against manual assessment followed by assessment using an open-label randomized control method.
  
  
  METHODS
  Patient zones were established in 3 wards of 2 large teaching hospitals, including 88 general and 18 intensive care unit ward beds.
  
  
  METHODS
  Consented regular ward nursing, medical, and allied health staff.
  
  
  METHODS
  Concordance between 40 hours of manual observation using trained hand hygiene auditors and automated measures of opportunities and compliance. Subsequent measured interventions were reminder beeps and written individual feedback.
  
  
  RESULTS
  When compared with manual observations, ultrasound monitoring underestimated percentage compliances by a nonsignificant mean (95% confidence interval [CI]) difference of 5.2% (-20.1% to 9.8%; [Formula: see text]). After the intervention, adjusted multivariate analysis showed mean (95% CI) overall compliance in the intervention arm was 6.8% (2.5%-11.1%; [Formula: see text]) higher than in the control arm. Results stratified by compliance at entry and exit showed that the effect of intervention was stronger for compliance at exit than at entry.
  
  
  CONCLUSIONS
  Our automated measure of hand hygiene compliance is valid when compared with the traditional gold standard of manual observations. As an interventional tool, ultrasound-based automated hand hygiene audits have significant benefit that can be built upon with enhancements and find increasing acceptance with time.
authors.affiliation: Department of Medicine, National University Health System, Singapore. mdcfda@nus.edu.sg
authors.forename: Dale A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Theresa
authors.initials: T
authors.lastname: Seetoh
authors.forename: Helen
authors.initials: H
authors.lastname: Oh May-Lin
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Viswanathan
authors.forename: Yanling
authors.initials: Y
authors.lastname: Toh
authors.forename: Wong Chiang
authors.initials: WC
authors.lastname: Yin
authors.forename: Loh
authors.initials: L
authors.lastname: Siw Eng
authors.forename: Tan Shire
authors.initials: TS
authors.lastname: Yang
authors.forename: Steve
authors.initials: S
authors.lastname: Schiefen
authors.forename: Minkyu
authors.initials: M
authors.lastname: Je
authors.forename: Ruey
authors.initials: R
authors.lastname: Feng Peh
authors.forename: Fiona
authors.initials: F
authors.lastname: Wei Ling Loke
authors.forename: Michael
authors.initials: M
authors.lastname: Dempsey
mesh_terms: D006801:Humans; D005246:Feedback; D019983:Guideline Adherence / Q000706:statistics & numerical data; D063373:Hand Hygiene / Q000592:standards / Q000706:statistics & numerical data; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D017010:Reminder Systems; D014463:Ultrasonography / Q000706:statistics & numerical data