title: Effect of a contact monitoring system with immediate visual feedback on hand hygiene compliance.
abstract: BACKGROUND
  Hand hygiene compliance is traditionally monitored by visual methods that are open to bias and strictly limited in time and place. Automatic monitoring may be more effective for infection control as well as performance management.
  
  
  OBJECTIVE
  To establish accuracy and acceptability of an automatic contact monitoring system for hand hygiene.
  
  
  METHODS
  Monitoring equipment was installed across 55 beds in three wards, and included modified identity badges, bedside furniture, sinks and alcohol gel dispensers. Badges were in near-skin contact (through uniform) and could detect alcohol vapour. All devices were linked by wi-fi. A traffic light system on the badge provided immediate feedback to staff and patients on the hand hygiene status of a member of staff on approach to a patient. Compliance was logged automatically. Following a period of immediate feedback, no visual feedback was given for two weeks. Subsequently, feedback was given using red/green lights for 10 days, followed by retrospective feedback to the ward. Hand hygiene was verified independently by an observer.
  
  
  RESULTS
  Hand hygiene compliance increased from 21% of 97 opportunities to 66% of 197 opportunities during active immediate feedback. Compliance decreased when feedback was provided to wards retrospectively. Six staff (26%) avoided wearing a badge, saying that it was too heavy or they were not on the ward all day. Only three of 30 patients stated that they would challenge staff who had not performed hand hygiene.
  
  
  CONCLUSIONS
  Automatic contact monitoring with immediate feedback was effective in increasing hand hygiene compliance, but feedback given retrospectively did not prevent a decrease in compliance.
authors.affiliation: Department of Microbiology and Virology, University College London Hospitals, London, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Storey
authors.affiliation: Department of Microbiology and Virology, University College London Hospitals, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: FitzGerald
authors.affiliation: Department of Microbiology and Virology, University College London Hospitals, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Moore
authors.affiliation: Heart Hospital, University College London Hospitals, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Knights
authors.affiliation: Institute for Occupational Ergonomics, Faculty of Engineering, University of Nottingham, Nottingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Atkinson
authors.affiliation: Institute for Occupational Ergonomics, Faculty of Engineering, University of Nottingham, Nottingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.affiliation: HCAI Service Users Research Forum, Faculty of Health and Human Sciences, University of West London, Brentford, UK.
authors.forename: O
authors.initials: O
authors.lastname: Freeman
authors.affiliation: Intromed Ltd, Leicester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Cryer
authors.affiliation: Department of Microbiology and Virology, University College London Hospitals, London, UK. Electronic address: peter.wilson@uclh.nhs.uk.
authors.forename: A P R
authors.initials: AP
authors.lastname: Wilson
mesh_terms: D004865:Equipment and Supplies, Hospital; D063373:Hand Hygiene / Q000592:standards*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008505:Medical Staff, Hospital; D010361:Patients
keywords: Contact monitoring; Hand hygiene; Healthcare-acquired infection