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The Effect of Automated Monitoring and Real-Time Prompting on Nurses’ Hand Hygiene Performance


CIN: Computers, Informatics, Nursing: October 2013 - Volume 31 - Issue 10 - p 498–504
doi: 10.1097/01.NCN.0000432124.53902.1d

Adequate hand hygiene compliance by healthcare staff is considered an effective method to reduce hospital-acquired infections. The electronic system developed at Toronto Rehabilitation Institute automatically detects hand hygiene opportunities and records hand hygiene actions. It includes an optional visual hand hygiene status indication, generates real-time hand hygiene prompting signals, and enables automated monitoring of individual and aggregated hand hygiene performance. The system was installed on a complex continuous care unit at the entrance to 17 patient rooms and a utility room. A total of 93 alcohol gel and soap dispensers were instrumented and 14 nurses were provided with the personal wearable electronic monitors. The study included three phases with the system operating in three different modes: (1) an inactive mode during the first phase when hand hygiene opportunities and hand hygiene actions were recorded but prompting and visual indication functions were disabled, (2) only hand hygiene status indicators were enabled during the second phase, and (3) both hand hygiene status and real-time hand hygiene prompting signals were enabled during the third phase. Data collection was performed automatically during all of the three phases. The system indicated significantly higher hand hygiene activity rates and compliance during the third phase, with both hand hygiene indication and real-time prompting functions enabled. To increase the efficacy of the technology, its use was supplemented with individual performance reviews of the automatically collected data.

Author Affiliations: Toronto Rehabilitation Institute, University Health Network, Toronto (Drs Levchenko and Fernie); Schegel Research Institute of Aging, University of Waterloo & Conestoga College, Kitchener (Dr Boscart); Department of Surgery, University of Toronto, Ontario, Canada (Dr Fernie).

This research was funded by the Canadian Institutes of Health Research (project number 200909MOP-210135-PH1-IOAA-19325) and Toronto Rehabilitation Institute. Toronto Rehabilitation Institute receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario.

There is a potential conflict of interest because of the anticipated commercialization of the hand hygiene monitoring system. This intellectual property is patent protected. Any future royalties generated will be distributed according to the policy at the Toronto Rehabilitation Institute. Two of the authors who are inventors of the technology may benefit from royalties in the future (Drs Levchenko and Fernie). Dr Fernie has committed to donating his share of royalties to Toronto Rehabilitation Institute.

Corresponding Author: Alexander I. Levchenko, PhD, P.Eng, TRI-UHN, 550 University Ave, Toronto, Ontario M5G 2A2, Canada (

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.