title: Evaluation of hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system.
abstract: BACKGROUND
  Hand hygiene is a major means for preventing healthcare-associated infections. One critical point in understanding poor compliance is the lack of relevant markers used to monitor practices systematically.
  
  
  METHODS
  This study analysed hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system in an infectious disease ward with 17 single bedrooms. Healthcare workers (HCWs) were tracked while performing routine care over 171 days. A multi-level multi-variate logistics model was used for data analysis. The main outcome measures were hand disinfection before entering the bedroom (outside use) and before entering the patient care zone, defined as the zone surrounding the patient's bed (inside/bedside use). Variables analysed included HCWs' characteristics and behaviour, patients, room layouts, path chains and duration of HCWs' paths.
  
  
  RESULTS
  In total, 4629 paths with initial hand hygiene opportunities when entering the patient care zone were selected, of which 763 (16.5%), 285 (6.1%) and 3581 (77.4%) were associated with outside use, inside/bedside use and no use, respectively. Hand hygiene is caregiver-dependent. The shorter the duration of the HCW's path, the worse the bedside hand hygiene. Bedside hand hygiene is improved when one or two extra HCWs are present in the room.
  
  
  CONCLUSIONS
  Hand hygiene compliance at the bedside, as analysed using the continuous monitoring system, depended upon the HCW's occupation and personal behaviour, number of HCWs, time spent in the room and (potentially) dispenser location. Meal tray distribution was a possible factor in the case of failure to disinfect hands.
authors.affiliation: Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Biostatistique et Technologies de l'Information et de la Communication, Hôpital de la Timone, Marseille, France. Electronic address: jean-charles.dufour@univ-amu.fr.
authors.forename: J-C
authors.initials: JC
authors.lastname: Dufour
authors.affiliation: Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Biostatistique et Technologies de l'Information et de la Communication, Hôpital de la Timone, Marseille, France; Institut Hospitalo Universitaire Mediterranée Infection, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Reynier
authors.affiliation: Institut Hospitalo Universitaire Mediterranée Infection, Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Boudjema
authors.affiliation: Institut Hospitalo Universitaire Mediterranée Infection, Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Soto Aladro
authors.affiliation: Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Biostatistique et Technologies de l'Information et de la Communication, Hôpital de la Timone, Marseille, France.
authors.forename: R
authors.initials: R
authors.lastname: Giorgi
authors.affiliation: Institut Hospitalo Universitaire Mediterranée Infection, Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Brouqui
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene; D015438:Health Behavior; D006282:Health Personnel; D006280:Health Workforce; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D057233:Radio Frequency Identification Device; D013997:Time Factors
keywords: Continuous monitoring; Electronic monitoring; Hand hygiene; Radiofrequency identification