Effect of intermittent deployment of an electronic monitoring system on hand hygiene behaviors in healthcare workers

Background: Improving hand hygiene compliance among healthcare professionals is the most effective way to reduce healthcare-acquired infections. Electronic systems developed to increase hand hygiene performance show promise but might not maintain staff participation over time. In this study, we investigated an intermittent deployment strategy to overcome potentially declining participation levels. Methods: An electronic monitoring system was deployed 3 times at 6-month intervals on a musculoskeletal rehabilitation nursing unit in Toronto. Each deployment lasted 4 consecutive weeks. Each wall-mounted soap and hand rub dispenser was outfitted with an activation counter to assess the impact of system deployments on overall handwashing activity. Results: System deployments took place in October 2016, April 2017, and October 2017. A total of 76,130 opportunities were recorded, with an aggregate hand hygiene performance of 67.43%. A total of 515,156 dispenser activations were recorded. There was a significant increase in aggregate dispenser use with every deployment and a decrease over several weeks following each withdrawal. Participation was high at the beginning of each deployment and declined during each deployment but was restored to a high level with the start of the next deployment. Conclusions: Intermittent deployment of an electronic monitoring intervention counteracts potential declines in participation rates sometimes seen with continuous system use. However, adoption of this strategy requires the acceptance of lower periods of performance between each deployment. (c) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc.