Video auditing with feedback improved hand hygiene compliance among HCWs

Armellino D. Clin Infect Dis. 2012;54:1-7.

Issue: March 2012

Hand hygiene compliance was significantly improved among health care workers in a hospital setting in which remote video auditing combined with real-time performance feedback was used to monitor hand hygiene performance.

Perspective from R. Brooks Gainer, MD

From June 2008 to June 2010, doorway motion sensors were installed in a 17-bed medical ICU to detect health care workers (HCWs) entering or exiting the room, and 21 cameras were installed with views of every sink and hand sanitizer dispenser. Motion sensors sent a signal to video auditors, who then monitored HCWs and recorded hand hygiene compliance as pass or fail.

Performance feedback was displayed in the hallways, and summary reports were delivered to supervisors after the first 16 weeks.

Of 60,542 hand hygiene observations during the first 16 weeks of video auditing (before feedback was given), fewer than 10% of HCWs passed (overall compliance rate of 6.5%). During the post-feedback period, 59,627 of 73,080 hand hygiene observations passed, with an overall compliance rate of 81.6%. This increase was maintained through 75 weeks with a compliance rate of 87.9%, according to the study.

“This technology allows one to capture and analyze large volumes of performance data with detailed stratification over a prolonged period of time,” the researchers wrote in the study. “By observing the intermittent fluctuations in performance throughout the study period and the subsequent action taken by the unit leaders to motivate staff to reclaim their high levels of performance, we believe ongoing monitoring is required to sustain high rates of hand hygiene compliance.”

Disclosure: This research was supported by the New York State Department of Health (C702049) for the one-time grant of $50,000 to fund the capital equipment.

Donald Kaye, MD

Proper hand hygiene is probably the first, second and third most important activity in infection control. A lack of adherence to hand hygiene is a problem across all health care settings, for nurses, for other non-physician health care providers and especially for physicians. Despite multiple education programs, adherence is often poor. Direct observation has been used as a tool successfully to improve adherence, but is difficult and requires much personnel time. The use of video auditing as in this presentation seems to be a very useful tool. Though probably expensive to set up on a facility-wide basis, once the initial investment is made, monitoring on a periodic long-term basis might prove to be cost effective. If people think/know that they are being watched, behavior tends to change.

- Donald Kaye, MD

Infectious Disease News Editorial Board member

Disclosure: Dr. Kaye reports no relevant financial disclosures.

Perspective

R. Brooks Gainer, MD

This paper and the accompanying editorial demonstrate that an overwhelming majority of health care workers (HCWs) at all levels of training still did not follow hand hygiene policies and procedures. Semmelweis's 1861 paper is still not being accepted. The current study by Armellino and colleagues is unique, but not practical for most health care settings due to the costs and patient issues raised by the editorial. I think some form of electronic monitoring of hand washing/hand gel-use as reported by Boyce, Sahud, and Swoboda is the direction that needs further study. I do find it amazing and frustrating that HCWs still haven't received the message on how something as simple as hand washing can be so beneficial to their patients, their colleagues and their environment. Unfortunately, the most often non compliant are our fellow physicians. The rest of the HCWs just follow the physicians example.

R. Brooks Gainer, MD

Infectious Disease News Editorial Board member

Disclosures: Dr. Gainer reports no relevant financial disclosures.