Are Your Healthcare Workers’ Hands Clean? Improving Hand Hygiene with Hand Hygiene Compliance Monitoring Systems

By Leilani Yoshida, DBA Student, Indiana Wesleyan University 

One may question why there is a need to discuss healthcare workers’ (HCWs) hand hygiene (HH) practices. Especially in light of the current state of the global pandemic; is it even possible that HCWs are not washing their hands properly? Furthermore, when people seek medical treatment, could it cause more harm than good? Unfortunately, the answer to these questions is “yes”, it is possible.  

Hand hygiene compliance (HHC) amongst healthcare workers continues to be an issue despite evidence indicating that it can lead to significant illness through hospital-acquired infections (HAIs). Although the impact of improper HH was first realized in the mid-1800s when Semmelweis and Holmes reported that HAIs were transmitted through healthcare workers’ hands, the Centers for Disease Control and Prevention indicate HCWs practice adequate handwashing less than half the times they should. This further results in one of 31 patients acquiring an HAI. Notwithstanding the health-related implications of failing to practice proper hand hygiene, the financial burden to health care systems is enormous, being reported to be between $28 to $45 billion.

Surprisingly, despite the devasting effects of the Covid-19 pandemic, when handwashing was declared an even more critical practice, proper hand hygiene is still problematic. With Covid-19 successfully shining the light on the necessity of following hand hygiene recommendations, some countries like China went to the lengths of increasing the Who’s “5 Moments” to 17. In addition, the CDC updated its handwashing suggestions and applied extra emphasis on the criticality of hand hygiene. Nevertheless, although there was an improvement in HHC during the early pandemic, the optimism toward long-term compliance was not sustained because compliance began to drop as restrictions were lifted.  

Improving Hand Hygiene Through HHCMS

One option in the quest to solve this widespread dilemma is through the use of hand hygiene compliance monitoring systems (HHCMS). These devices were designed with healthcare workers and patient safety in mind by providing the ability to track and alert HCWs’ hand hygiene practices. Available in multiple designs such as badges, clips, and wristband options like those produced by Vitalacy, this equipment is touted to be conveniently worn by the healthcare workers and provides real-time hand washing reminders at the point of care.

In addition to the convenient wearability of these devices, the most significant benefit is increasing HHC and reducing illness. Companies like BioVigil promote their devices can reduce HAIs by as much as 83% and sustains hand hygiene compliance by 97%. Further, companies such as Ecolab claim their equipment can help improve the factors that comprise up to 22% of the Leapfrog Hospital Safety Grade. However, despite these features and promising statistics, some hospitals that have employed these services have not recognized the desired results. 

Challenges with Implementing HHCMS

One primary consideration affecting the sought-after outcome of improving hand hygiene compliance and reducing HAIs is the healthcare staff’s acceptance of the HHCMS in hospital environments. According to HHCMS manufacturers, their products provide the tools necessary to increase hand hygiene compliance; however, the equipment is not always met with open arms. Examples of common HCW concerns with using HHCMS include: 

• Data accuracy
• Product design issues
• Intrusion of privacy

Data Accuracy

As with any activity where performance is measured based on data, the information’s accuracy is of the utmost importance. However, the data accuracy of HHCMS has been identified as one of the HCWs’ key concerns. In a survey conducted by Levin et al., 76% of staff indicated they were disappointed by the system’s performance, explicitly calling out inconsistencies in capturing hand hygiene opportunities and inaccuracies in reporting results. As one can imagine, this inaccurate data leads to loss of confidence, frustration, and potentially refusal to use the equipment. 

Product Design Issues

Product design has also been reported as a leading cause of dissatisfaction with HHCMS, with complaints of equipment size and shape topping the list. Criticisms include the device being too bulky, uncomfortable, cumbersome, and distracting. In addition, 44% of surveyed healthcare workers indicated wearing the HHCMS was inconvenient, establishing the need for the equipment to be as comfortable as possible. 

Intrusion of Privacy

The intrusion of privacy is another area of concern related to HCW aversion to using HHCMS. Healthcare workers have expressed uneasiness about HHCMS being intrusive with its ability to track their locations. Further, some HCWs are so dissatisfied with the thought of HHCMS and their tracking abilities that they have termed the equipment as “Big Brother” due to feelings of being watched or controlled by their management. 

Overcoming HHCMS Resistance

Although some obstacles may need to be overcome, all is not lost; multiple tactics can be used to address the healthcare workers’ concerns. First, leadership commitment and engagement in the process are imperative. Not only do leaders play a key role in sustaining HH and HHCMS compliance by serving as role models, coaches, and champions, but they can also address non-compliant workers and help identify barriers to success.

Next, empowering employees is another crucial factor if HHCMS implementation and sustainment are desired. HCWs should be able to provide input in developing the HHCMS, offering insight into their regular routines and identifying complex situations and constraints. This effort may also help with the perception of data accuracy issues as the systems could be logging activities that are inconsistent with real-life situations. Moreover, HCWs should be given the opportunity to voice their opinions and concerns with evidence that some action will be taken when appropriate. 

Additionally, implementing a rewards and recognition program should be considered. While this can be accomplished using monetary incentives, it is really up to the organization as to the best way to motivate their employees. Employees appreciate being recognized for their efforts and accomplishments and may also be pleased with symbolic awards such as cards, certificates, or public recognition. 

In today’s environment, where practicing proper hand hygiene is critical for everyone and even more necessary for healthcare community members, HHCMS are a viable solution to help address compliance concerns. While there may be some initial resistance or hesitancy with using the equipment, implementing employee-focused and supportive strategies can significantly reduce these reactions. Even though hand hygiene compliance issues have been challenging for hundreds of years, it is time to take a stand —non-compliance will not be accepted, and to leverage the available tools, including HHCMS, to help accomplish this task. 

Leilani Yoshida is a Doctor of Business Administration student at Indiana Wesleyan University. Yoshida has partnered with an HHCMS manufacturer for the last three years to research the benefits and determine how to implement the equipment in hospital environments successfully.