title: Accuracy of a radiofrequency identification (RFID) badge system to monitor hand hygiene behavior during routine clinical activities.
abstract: BACKGROUND
  Hand hygiene (HH) is a critical part of infection prevention in health care settings. Hospitals around the world continuously struggle to improve health care personnel (HCP) HH compliance. The current gold standard for monitoring compliance is direct observation; however, this method is time-consuming and costly. One emerging area of interest involves automated systems for monitoring HH behavior such as radiofrequency identification (RFID) tracking systems.
  
  
  METHODS
  To assess the accuracy of a commercially available RFID system in detecting HCP HH behavior, we compared direct observation with data collected by the RFID system in a simulated validation setting and to a real-life clinical setting over 2 hospitals.
  
  
  RESULTS
  A total of 1,554 HH events was observed. Accuracy for identifying HH events was high in the simulated validation setting (88.5%) but relatively low in the real-life clinical setting (52.4%). This difference was significant (P < .01). Accuracy for detecting HCP movement into and out of patient rooms was also high in the simulated setting but not in the real-life clinical setting (100% on entry and exit in simulated setting vs 54.3% entry and 49.5% exit in real-life clinical setting, P < .01).
  
  
  CONCLUSIONS
  In this validation study of an RFID system, almost half of the HH events were missed. More research is necessary to further develop these systems and improve accuracy prior to widespread adoption.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. Electronic address: lpineles@epi.umaryland.edu.
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Pineles
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Health Care System, Baltimore, MD.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Limper
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Weber
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Thom
authors.affiliation: Iowa City VA Health Care System and Divisions of General Internal Medicine and Infectious Diseases, Carver College of Medicine, Iowa City, IA.
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Emily
authors.initials: E
authors.lastname: Landon
mesh_terms: D001291:Attitude of Health Personnel; D001330:Electronic Data Processing / Q000379:methods; D062665:Epidemiological Monitoring; D063373:Hand Hygiene / Q000379:methods*; D006802:Human Activities; D006801:Humans; D017053:Infection Control / Q000379:methods*; D009946:Organothiophosphorus Compounds; D057233:Radio Frequency Identification Device; D013686:Telemetry / Q000379:methods*
chemical_list: D009946:Organothiophosphorus Compounds; C014655:methamidophos
keywords: Compliance; Direct observation; Electronic monitoring; Hand washing; Infection control