A show of hands

Sept. 28, 2021
Technology makes a solid showing in the world of hand hygiene compliance monitoring

Nearly two years after U.S. hospitals documented their first cases of COVID-19, calls for vigilance in hand hygiene protocols have not let up.

Neither has the demand for hand hygiene-related products.

“Hand hygiene has always been a top priority for healthcare facilities,” says Deborah Chung, North America Marketing Manager, Healthcare/Professional Hygiene for Essity.

The emergence of the SARS-CoV-2 virus, followed by its virulent and highly transmissible Delta variant, have kept hand soaps, hand sanitizers – and especially EMS technology – front and center.

“People are now more aware of their own need to follow proper hygiene practices,” Chung said. Her company makes Tork skincare solutions, including Tork Alcohol Gel Hand Sanitizer, and Tork Vision Cleaning, an electronic monitoring system (EMS) that reports hand towel, toilet paper and skincare product use. It uses high-resolution indoor positioning technology which can, according to the company’s website, “provide healthcare professionals with more accurate data that can be presented to staff in real time.”

It’s one of a diverse and growing array of technology-based hand hygiene monitors now on the market.

The pandemic heightened awareness about the virus’ high transmissibility, and the need to find products, “to effectively wash, dry and sanitize hands to prevent the spread of illness,” Chung said.

Demand for hand sanitizer, across all segments of the healthcare landscape, has been strong.

During COVID-19’s early surges, “many hospitals across the country reported hand sanitizer usage of three-to-four times normal levels,” says Jaimee Rosenthal, Acute Healthcare Market Director of GOJO Industries, which makes PURELL hand sanitizers.

To keep up with elevated demand, she said, “GOJO substantially increased both production and distribution capacity and created a vertically integrated supply chain.” Rosenthal said. Her company responded quickly to the spike in demand, “to ensure we can be even more effective and efficient as we support our customers.”Yessica Artzerounian notes several purchasing trends in her role as Senior Portfolio Executive at Vizient.

Her company, which boasts a membership of more than half the healthcare organizations in the U.S., leverages its scale as purchasing power for hospitals, academic medical centers, pediatric and other healthcare facilities.

Recently, Artzerounian said, “our members have diversified their purchasing strategy to incorporate different sourcing streams.”

She has seen other market changes too.

“Our members have pivoted from gel hand sanitizing products to foam products when possible,” she said. “Foam has efficient sanitizing dosage that improves the total cost investment and higher skin health satisfaction reviews from our frontline users.”


Artzerounian said the product diversification she has seen in members’ purchasing habits includes increased investment in electronic monitoring.

“Infection Prevention teams across the U.S. are revitalizing their overall approach to hand hygiene and looking into technology such as hand hygiene compliance monitoring systems to help them do so,” she said.

“The goal is to implement a hand hygiene program for their team to provide top quality care by committing to high hand hygiene standards to reduce infections or the spread of disease,” she said.

Healthcare products company GOJO offers its own technology-based monitoring system.

The GOJO SMARTLINK system was used recently in a hand hygiene compliance study conducted at The University of Chicago Medical Center. Findings from that study were published in the July issue of the Journal of American Medical Association.1

“An infrared sensor anonymously records all dispenser uses, and entries into and exits from inpatient rooms,” to estimate hand hygiene compliance, according to an explanation of GOJO’s product in the study summary.

The data collected by these devices can reveal useful information to healthcare facility leadership and staff, not only by looking at day to day hand hygiene compliance, but by revealing more long-term compliance trends.

For instance, Rosenthal of GOJO said, “Hand hygiene compliance rates increased dramatically during the first few months of the pandemic but have since gone back to more typical levels for hospitals.”

An ability to pinpoint such information accurately can assist healthcare workers in reversing those compliance declines and help save lives in the process.

The Hawthorne Effect

GP PRO’s own EMS, the SafeHaven Personal Hand Hygiene Monitoring System, was activated in April of this year at Gulfside Healthcare Services facilities in Pasco County, Florida.

Gulfside issued the small device to 220 employees who work in hospice, home health and palliative care. The portable device clips onto clothing or a lanyard, which allows the user to perform hand hygiene at any time. A small screen on the device shows the user their individual performance data. Each time a user passes one of several base stations, that data is uploaded to the Cloud and is then available on a live facility dashboard that displays aggregated facility data for management.

“You can also log in as a personal user,” to check on your own hand hygiene habits, said Lindsay Cole, who runs nursing and CNA training programs at Gulfside, and helped implement the system trials.

Custom programming allows each facility to set and alter goals for different users, “depending on what is realistic for a particular job,” Cole said. “Some of our staff members visit five or six locations a day, so these (devices) are our eyes when employees are off-site.”

Cole said she has staff members train other staff members, and publicly recognizes employees whose hand hygiene behavior is exemplary.

Data generated by SafeHaven and other electronic hand hygiene monitoring systems, over the course of the last several years, have become increasingly regarded as reliable, according to a study published last year in the Journal of Infection Prevention.

The study, conducted in a National Health Service acute care medical ward in the United Kingdom, sought to measure the accuracy of EMS products as compared with manual observation-documentation techniques.2 Those techniques, which rely upon human monitors, are still the industry standard for hand hygiene compliance monitoring.

Efficiency of EMS, according to the study’s summary, “is estimated to be tenfold compared to manual monitoring.”

“Less effort is required (with EMS) than with manual observation which is laborious, expensive in terms of manpower and subject to bias,” according to the summary.

The range of electronic monitoring systems now on the market has grown significantly in a few short years. The ongoing pandemic provided the necessary incentive for an increasing number of healthcare facility leaders to take the leap and invest in monitoring technology.

Among electronic products now on the market is Ecolab’s Hand Hygiene Compliance Monitoring System, which works by employing what its website literature calls the “Patient Zone.”

The system defines an area around a hospital patient’s bed for electronic monitoring, “to detect every hand- hygiene opportunity.”

A badge worn by healthcare workers, “measures and records every hand hygiene event,” Ecolab’s website explains. “Visual and audible feedback is immediate.”

Data is compiled, “to track performance by individual, department hospital or system,” according to the website. “Compliance trends are reported as well as equipment status, sanitizer,” etc.

Paul Alper is now the VP Patient Safety Innovation for Medline Industries, Inc. through an exclusive engagement with his consulting practice, Next Level Strategies, LLC. Medline recently formed a collaborative partnership with Intelligent Observation, to offer a hand hygiene compliance monitoring system under the brand name, IntelObserve. The technology platform behind the product – Near Field Magnetic Induction or NFMI – is new and different, Alper said.

The system monitors, “both hand washing with soap and water and the use of hand sanitizer with a high rate of accuracy”, he said, “providing highly actionable data to drive sustainable improvement.”

Alper, like Artzerounian of Vizient, noted that technology-based compliance monitoring is beginning to gain real traction.

The uptick in interest is due, in part, he said, to Medicare reimbursement penalties for Hospital-Acquired Conditions (HACs), and to increased standards for hand hygiene compliance, generally. Those standards have leapt forward, thanks to an industry watchdog organization called the Leapfrog Group. Leapfrog issues a grade to each hospital that is willing to be transparent with patient safety records – and most hospitals are. The grades are posted on the group’s website.

But the tipping point that may very well change the landscape of hand hygiene entirely is the emergence and persistence of COVID-19.

It doesn’t hurt proponents of EMS that a number of reputable institutions have now compared their rates of accuracy and influence on behavior to the traditional, human means of monitoring hand hygiene compliance.

According to results from the University of Chicago study, EMS is “far more effective than human observation in measuring compliance.”

One reason for the difference, according to the study summary, is that mere observation practices capture too few hand hygiene events, “leading to inaccurate measurements.”

EMS can help resolve those inaccuracies by monitoring consistently, and constantly.

Inaccuracy created through traditional human monitoring, according to the U.K. study, is due also to the “Hawthorne Effect.” This principle posits that human behavior changes when the subject being monitored is aware that he is being observed by another person.

Hand hygiene compliance, according to this principle, will increase during the time a subject is being monitored in this way, then drop off precipitously once the perceived observation ends, according to the principle.

Compliance data, when collected in this way, can be skewed, “by a factor of three,” according to the U.K. study.

The evidence from such studies, Alper said, suggests that long-accepted methods of direct observation, “lead to overstated compliance and a false sense of security.”

And that, he says, leads to complacency.

These studies no doubt contribute to the growing popularity of EMS. It’s a theme familiar to Vizient’s Yessica Artzerounian.

“We expect to see an increase in use for these systems as we continue to navigate through COVID hospitalization spikes and the upcoming flu season,” she said.

“2021 and 2022 will be watershed years,” said Alper. Technology-based hand hygiene monitoring systems, “are going to be much more widely adopted.”

1. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2779293/
2.  https://journals.sagepub.com/doi/full/10.1177/1757177 420907999