Utility of electronic hand hygiene counting devices for measuring physicians' hand hygiene adherence applied to outpatient settings.
Our objectives were to evaluate the utility of electronic hand hygiene counting devices in outpatient settings and the impact of results feedback on physicians' hand hygiene behaviors.



We installed 130 electronic hand hygiene counting devices in our redesigned outpatient department. We remotely monitored physicians' hand hygiene practices during outpatient examinations and calculated the adherence rate as follows: number of hand hygiene counts divided by the number of outpatients examined multiplied by 100. Physician individual adherence rates were also classified into 4 categories.



Two hundred and eighty physicians from 28 clinical departments were monitored for 3 months. The overall hand hygiene adherence rate was 10.7% at baseline, which improved significantly after feedback to 18.2% in the third month. Of the clinical departments, 78.6% demonstrated significant improvement in hand hygiene compliance. The change in the percentage of physicians in each category before and after feedback were as follows: very low (84.3% to 72.1%), low (8.6% to 14.3%), moderate (2.9% to 8.9%), and high (4.3% to 4.6%), from the first to third month, respectively. Based on category assessment, 17.1% of physicians were classified as responders.



Physicians' adherence to hand hygiene practices during outpatient examinations was successfully monitored remotely using electronic counting devices. Audit and feedback of adherence data may have a positive impact on physicians' hand hygiene compliance.
Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan; Department of Nursing, Mie University Hospital, Tsu, Japan.
Akie
A
Arai
Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan. Electronic address: m-tanabe@clin.medic.mie-u.ac.jp.
Masaki
M
Tanabe
Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan.
Akiko
A
Nakamura
Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan; Department of Pharmacy, Mie University Hospital, Tsu, Japan.
Daisuke
D
Yamasaki
Department of Pharmacy, Mie University Hospital, Tsu, Japan.
Yuichi
Y
Muraki
Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan.
Toshihiro
T
Kaneko
Department of Nursing, Mie University Hospital, Tsu, Japan.
Ayako
A
Kadowaki
Department of Cardiology, Mie University Hospital, Tsu, Japan.
Masaaki
M
Ito
D000554:Ambulatory Care Facilities; D001331:Automation; D001521:Behavior Therapy / Q000379:methods; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D008330:Management Audit / Q000379:methods*; D010820:Physicians
Compliance; Electronic counting device; Hand hygiene; Monitoring