title: The use of real-time feedback via wireless technology to improve hand hygiene compliance.
abstract: BACKGROUND
  Hand hygiene (HH) is widely regarded as the most effective preventive measure for health care-associated infection. However, there is little robust evidence on the best interventions to improve HH compliance or whether a sustained increase in compliance can reduce rates of health care-associated infection.
  
  
  METHODS
  To evaluate the effectiveness of a real-time feedback to improve HH compliance in the inpatient setting, we used a quasiexperimental study comparing the effect of real-time feedback using wireless technology on compliance with HH. The study was conducted in two 20-bed step-down units at a private tertiary care hospital. Phase 1 was a 3-month baseline period in which HH counts were performed by electronic handwash counters. After a 1-month washout period, a 7-month intervention was performed in one step-down unit while the other unit served as a control.
  
  
  RESULTS
  HH, as measured by dispensing episodes, was significantly higher in the intervention unit (90.1 vs 73.1 dispensing episodes/patient-day, respectively, P = .001). When the intervention unit was compared with itself before and after implementation of the wireless technology, there was also a significant increase in HH after implementation (74.5 vs 90.1 episodes/patient-day, respectively, P = .01). There was also an increase in mean alcohol-based handrub consumption between the 2 phases (68.9 vs 103.1 mL/patient-day, respectively, P = .04) in the intervention unit.
  
  
  CONCLUSIONS
  We demonstrated an improvement in alcohol gel usage via implementation of real-time feedback via wireless technology.
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: a.marra@uol.com.br.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Thiago Zinsly
authors.initials: TZ
authors.lastname: Sampaio Camargo
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Thyago Pereira
authors.initials: TP
authors.lastname: Magnus
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Rosangela Pereira
authors.initials: RP
authors.lastname: Blaya
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Gilson Batista
authors.initials: GB
authors.lastname: Dos Santos
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Luciana Reis
authors.initials: LR
authors.lastname: Guastelli
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Rodrigo Dias
authors.initials: RD
authors.lastname: Rodrigues
authors.affiliation: Division of Research and Development, I-HealthSys, São Carlos, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Prado
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Elivane da Silva
authors.initials: Eda S
authors.lastname: Victor
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Humberto
authors.initials: H
authors.lastname: Bogossian
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Julio Cesar Martins
authors.initials: JC
authors.lastname: Monte
authors.affiliation: Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
authors.affiliation: Division of Logistics and Supplies, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Carlos Kazume
authors.initials: CK
authors.lastname: Oyama
authors.affiliation: Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000438:Alcohols; D003199:Computer Systems; D005246:Feedback; D005782:Gels; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000592:standards* / Q000706:statistics & numerical data*; D064548:Hand Sanitizers; D006801:Humans; D057233:Radio Frequency Identification Device; D062606:Tertiary Care Centers; D013997:Time Factors; D059015:Wireless Technology
chemical_list: D000438:Alcohols; D005782:Gels; D064548:Hand Sanitizers
keywords: Alcohol hand rub; Communication system; Electronic handwash counters; Feedback loop; Health care worker performance; Innovation; Positive deviance; Quasiexperimental study; RFID; Zigbee