Implementation of a Hospital-wide Electronic Hand Hygiene Monitoring Program Reduces Healthcare-acquired Infections in a Level I Trauma Hospital

Background Despite evidence that increased hand hygiene compliance (HHC) has been attributed to reduction in healthcare-acquired infections (HAIs), HHC in healthcare is 40% today. Non-adherence varies by discipline (job roles). An electronic hand hygiene compliance monitoring system (eHHCMS) measuring compliance at the bedside has been shown to improve and sustain HHC between 85-95%. Methods An urban, 353-bed Level I trauma hospital monitored HHC from April 2018-April 2019 using a direct observation model whereby selected staff performed observations of their peers’ HHC. eHHCMS was installed and HHC monitored from May 2019-October 2019. The standardized infection ratio (SIR) for HAIs were measured using National Healthcare Safety Network analysis tools throughout the pre and post-implementation period. Costs of HAI were calculated using peer-reviewed literature and hospital-specific data. Results Hospital-wide HHC using the direct observation method was documented as 91% with 6362 observations annually. However, at baseline the eHHCMS documented HHC at 61.5%. After training and implementation, hospital-wide HHC was sustained at 88% with 2,399,020 recorded events. HHC varied across job roles, ranging from 72-92%; nursing (88%), nursing assistants (76%) and notably, providers (multiple specialties) had the highest HHC at 92%. The hospital-wide CAUTI, CLABSI and CDI ratios decreased by 17.7%, 36.2% and 16.5% respectively in the post-implementation period. Conclusions eHHCMS is improving and sustaining HHC 43.1% over baseline with less subjectivity and markedly increased observation opportunities. The ability to measure compliance by job role is helping focus improvement efforts. HAI SIRs and associated cost is decreasing significantly after implementation of eHHCMS. Even considering the impact of other concurrent infection prevention interventions, HHC remains paramount in reducing our HAIs.