Automated and electronically assisted hand hygiene monitoring systems: a systematic review.
BACKGROUND
Hand hygiene is one of the most effective ways to prevent transmission of health care-associated infections. Electronic systems and tools are being developed to enhance hand hygiene compliance monitoring. Our systematic review assesses the existing evidence surrounding the adoption and accuracy of automated systems or electronically enhanced direct observations and also reviews the effectiveness of such systems in health care settings.


METHODS
We systematically reviewed PubMed for articles published between January 1, 2000, and March 31, 2013, containing the terms hand AND hygiene or hand AND disinfection or handwashing. Resulting articles were reviewed to determine if an electronic system was used.


RESULTS
We identified 42 articles for inclusion. Four types of systems were identified: electronically assisted/enhanced direct observation, video-monitored direct observation systems, electronic dispenser counters, and automated hand hygiene monitoring networks. Fewer than 20% of articles identified included calculations for efficiency or accuracy.


CONCLUSIONS
Limited data are currently available to recommend adoption of specific automatic or electronically assisted hand hygiene surveillance systems. Future studies should be undertaken that assess the accuracy, effectiveness, and cost-effectiveness of such systems. Given the restricted clinical and infection prevention budgets of most facilities, cost-effectiveness analysis of specific systems will be required before these systems are widely adopted.
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Melissa A
MA
Ward
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Iowa City VA Health Care System, Iowa City, IA.
Marin L
ML
Schweizer
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Philip M
PM
Polgreen
VA Boston Health Care System, West Roxbury, MA; Boston University School of Medicine, Jamaica Plain, MA.
Kalpana
K
Gupta
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Iowa City VA Health Care System, Iowa City, IA.
Heather S
HS
Reisinger
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Iowa City VA Health Care System, Iowa City, IA. Electronic address: eli.perencevich@va.gov.
Eli N
EN
Perencevich
D001331:Automation / Q000191:economics / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D004582:Electronics, Medical / Q000191:economics / Q000379:methods*; D062665:Epidemiological Monitoring; D063373:Hand Hygiene / Q000191:economics / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*
Hand hygiene