title: Comparison of human and electronic observation for the measurement of compliance with hand hygiene.
abstract: BACKGROUND
  Monitoring of hand hygiene is an important part of the improvement of hospital quality indicators.
  
  
  METHODS
  This study was prospectively performed over a 14-week (electronic observer) period from December 3, 2013-March 9, 2014, to evaluate hand hygiene compliance in an adult step-down unit. We compared electronic handwash counters with the application of radiofrequency identification (RFID - ZigBee; i-Healthsys, São Carlos, Brazil) (electronic observer), which counts each activation of the alcohol gel dispenser to direct observation (human observer) using the iScrub application.
  
  
  RESULTS
  For the overall time period of simultaneous electronic and human observation, we found that the electronic observer identified 414 hand hygiene episodes, whereas the human observers identified 448 episodes. Therefore, we found 92% (95% confidence interval [CI], 90%-95%) overall concordance (414/448), with an intraclass correlation coefficient of .87 (95% CI, 0.77-0.92).
  
  
  CONCLUSIONS
  Our RFID (ZigBee) system showed good accuracy (92%) and is a useful method to monitor hand hygiene compliance.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Miguel Almeida O
authors.initials: MA
authors.lastname: Filho
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: Thyago Pereira
authors.initials: TP
authors.lastname: Magnus
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: Division of Research and Development, i-Healthsys, São Carlos, Brazil.
authors.forename: Tales Roberto
authors.initials: TR
authors.lastname: de Souza Santini
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Elivane
authors.initials: E
authors.lastname: da Silva Victor
authors.affiliation: Division of Research and Development, i-Healthsys, São Carlos, Brazil.
authors.forename: Eder Issao
authors.initials: EI
authors.lastname: Ishibe
authors.affiliation: Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Oscar Fernando
authors.initials: OF
authors.lastname: Pavão Dos Santos
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: D000328:Adult; D001938:Brazil; D062665:Epidemiological Monitoring; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies
keywords: Hand hygiene monitor; Handwash; Hawthorne effect; Radiofrequency identification; Zigbee