Electronic hand hygiene monitoring systems can be well-tolerated by health workers: Findings of a qualitative study

Should automated electronic hand-hygiene monitoring systems be implemented in routine patient care? Systematic review and appraisal with Medical Research Council Framework for Complex Interventions

Manual hand-hygiene audit is time-consuming, labour-intensive and inaccurate. Automated hand-hygiene monitoring systems (AHHMSs) offer advantages (generation of standardized data, avoidance of the Hawthorne effect). World Health Organization Guidelines for Hand Hygiene published in 2009 suggest that AHHMSs are a possible alternative. The objective of this review was to assess the current state of the literature for AHHMSs and offer recommendations for use in real-world settings. This was a systematic literature review, and publications included were from the time that PubMed commenced until 19th November 2023. Forty-three publications met the criteria. Using the Medical Research Council's Framework for Developing and Evaluating Complex Interventions, two were categorized as intervention development studies. Thirty-nine were evaluations. Two described implementation in real-world settings. Most were small scale and short duration. AHHMSs in conjunction with additional intervention (visual or auditory cue, performance feedback) could increase hand hygiene compliance in the short term. Impact on infection rates was difficult to determine. In the few publications where costs and resources were considered, time devoted to improving hand hygiene compliance increased when an AHHMS was in use. Health workers' opinions about AHHMSs were mixed. In conclusion, at present too little is known about the longer-term advantages of AHHMSs to recommend uptake in routine patient care. Until more longer-term accounts of implementation (over 12 months) become available, efforts should be made to improve direct observation of hand hygiene compliance to improve its accuracy and credibility. The Medical Research Council Framework could be used to categorize other complex interventions involving use of technology to prevent infection to help establish readiness for implementation.

Central aspects when implementing an electronic monitoring system for assessing hand hygiene in clinical settings: A grounded theory study

Background

New technologies, such as electronic monitoring systems, have been developed to promote increased adherence to hand hygiene among healthcare workers. However, challenges when implementing these technologies in clinical settings have been identified.

Aim

The aim of this study was to explore healthcare workers' experiences when implementing an electronic monitoring system to assess hand hygiene in a clinical setting.

Method

Interviews with healthcare workers (registered nurses, nurse assistants and leaders) involved in the implementation process of an electronic monitoring system (n = 17) were conducted and data were analyzed according to the grounded theory methodology formulated by Strauss and Corbin.

Results

Healthcare workers' experiences were expressed in terms of leading and facilitating, participating and contributing, and knowing and confirming. These three aspects were merged together to form the core category of collaborating for progress. Leaders were positive and committed to the implementation of the electronic monitoring system, endeavouring to enable facilitation and support for their co-workers (registered nurses and nurse assistants). At the same time, co-workers were positive about the support they received and contributed by raising questions and demands for the product to be used in clinical settings. Moreover, leaders and co-workers were aware of the objective of implementing the electronic monitoring system.

Conclusion

We identified dynamic collective work between leaders and co-workers during the implementation of the electronic monitoring system. Leadership, participation and knowledge were central aspects of enhancing a collaborative process. We strongly recommend involving both ward leaders and users of new technologies to promote successful implementation.

Office Workers' Views About the Uses, Concerns, and Acceptance of Hand Hygiene Data Collected From Smart Sanitizers: Exploratory Qualitative Interview Study

BACKGROUND

COVID-19 and the prospect of future pandemics have emphasized the need to reduce disease transmission in workplaces. Despite the well-established link between good hand hygiene (HH) and employee health, HH in nonclinical workplaces has received little attention. Smart sanitizers have been deployed in clinical settings to motivate and enforce HH. This study is part of a large project that explores the potential of smart sanitizers in office settings.

OBJECTIVE

Our previous study found that for office workers to accept the deployment of smart sanitizers, they would need to find the data generated as useful and actionable. The objectives of this study were to identify (1) the potential uses and actions that could be taken from HH data collected by smart sanitizers (2) the concerns of office workers for the identified uses and actions and (3) the circumstances in which office workers accept HH monitoring.

METHODS

An interview study was conducted with 18 office workers from various professions. Interview questions were developed using a framework from personal informatics. Transcripts were analyzed thematically.

RESULTS

A wide range of uses of smart sanitizer data was identified including managing hygiene resources and workflows, finding operating sanitizers, communicating the (high) standard of organizational hygiene, promoting and enforcing organizational hygiene policies, improving workers' own hygiene practices, executing more effective interventions, and identifying the causes of outbreaks. However, hygiene is mostly considered as a private matter, and it is also possible that no action would be taken. Office workers were also concerned about bullying, coercion, and use of hygiene data for unintended purposes. They were also worried that the data could be inaccurate or incomplete, leading to misrepresentation of hygiene practices. Office workers suggested that they would be more likely to accept monitoring in situations where hygiene is considered important, when there are clear benefits to data collection, if their privacy is respected, if they have some control over how their data are collected, and if the ways in which the data will be used are clearly communicated.

CONCLUSIONS

Smart sanitizers could have a valuable role in improving hygiene practices in offices and reducing disease transmission. Many actionable uses for data collected from smart systems were identified. However, office workers consider HH as a personal matter, and acceptance of smart systems is likely to be dynamic and will depend on the broad situation. Except when there are disease outbreaks, smart systems may need to be restricted to uses that do not require the sharing of personal data. Should organizations wish to implement smart sanitizers in offices, it would be advisable to consult widely with staff and develop systems that are customizable and personalizable.

An interactive feedback system for increasing hand antisepsis adherence in stationary intensive care

BACKGROUND

Pathogens causing infections are in many cases transmitted via the hands of personnel. Thus, hand antisepsis has strong epidemiological evidence of infection prevention. Depending on various factors, hand antisepsis adherence ranges between 9.1% and 85.2%.

AIM

To evaluate a new transponder system that reminded medical staff to use an alcohol-based hand rub based on indication by giving real-time feedback, to detect hand antisepsis adherence.

METHODS

The monitoring system consisted of three components: a portable transponder detecting alcohol-based hand rub and able to give feedback; a beacon recognizing entries to and exits from the patient's surroundings; and a sensor placed at the hand-rub dispensers to count the number of hand rubs. With these components, the system provided feedback when hand antisepsis was not conducted although it was necessary according to moments 1, 4, and 5 of hand antisepsis. Adherence was measured in two use-cases with five phases, starting with the baseline measurement followed by intervention periods and phases without intervention to test the sustainability of the feedback.

FINDINGS

Using the monitoring system, hand antisepsis adherence was increased by up to 104.5% in comparison to the baseline measurement. When the intervention ceased, however, hand antisepsis adherence decreased to less than or equal to the baseline measurement.

CONCLUSION

A short-term intervention alone is not sufficient to lead to a long-term change in hand antisepsis adherence. Rather, permanent feedback and/or the integration in a multi-modal intervention strategy are necessary.

Developing Internet of Things-related ISO 10001 Hand Hygiene Privacy Codes in healthcare

Purpose

Augmentation of an ISO 10001 code system for healthcare worker (HW) satisfaction with ISO/IEC 27701 and ISO/IEC 29184 privacy-related subsystems is shown. Four specific codes regarding the privacy of HWs using electronic devices for hand hygiene (HH) monitoring and the related activities are presented.

Design/methodology/approach

HWs’ concerns involving automated hand hygiene monitoring technologies were identified through a literature review and classified. Privacy codes (PCs) that deal with such concerns were developed. ISO/IEC 27701 requirements for privacy information were mapped to the elements of these codes, labelled as “Healthcare Workers’ Hand Hygiene Privacy Codes (HW-HH-PCs)”. Both ISO/IEC 27701 and ISO/IEC 29184 guidelines for Privacy Notices and consent were linked with the activities for preparing the code resources.

Findings

Components of an ISO/IEC 27701 system, the guidance of ISO/IEC 29184 and the definitions provided in ISO/IEC 29100 can assist the preparation of HW-HH-PCs and the required resources. An ISO/IEC 29184 Privacy Notice can be used as input for developing an Informed Consent Form, which can be implemented to suit two of the four developed HW-HH-PCs.

Practical implications

HW-HH-PCs and the supporting resources, which healthcare organizations could implement to potentially increase quality assurance of an automated HH monitoring service, are illustrated.

Originality/value

Integrative augmentation of ISO 10001:2018, ISO/IEC 27701:2019 and ISO/IEC 29184:2020 within an underlying framework from ISO/IEC 20000–1:2018 for information technology service, together with the related examples of privacy-related customer satisfaction codes and the corresponding resources, is introduced.