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Lauren Wilcox

November 28, 2021

Delaware Technical Community College

NUR 410 Nursing Informatics


Hand Hygiene Compliance in Hospitals

Handwashing and hand sanitizing is an essential part of the nursing practice.

Handwashing/hand sanitizing is the way to prevent hospital-acquired infections (HAI) and from

patients from acquiring these infections. Protecting not only patients but also ourselves as nurses

is important in keeping us in the best health possible so we can give our patients the best care

possible. Hand hygiene can sometimes be overlooked because of the number of patients a nurse

has, how busy they are, etc. Performing hand hygiene should be done before entering a patient’s

room and when leaving. Using hand sanitizer, in most cases, is acceptable. Some exceptions to

this would be patients on precautions, such as C. diff or COVID, when the nurse has visibly

soiled hands, or if it has been a while since the nurse has washed their hands. Hand sanitizer

does a good job of killing germs and it is good to use when going in between patient’s rooms, but

hand sanitizer should only be used so many times before hand washing should be performed and

certain bacterias/viruses are not killed by hand sanitizer, which can then lead them to be spread

to another patient. Practicing good hand hygiene has been a constant topic in the healthcare field

and has needed even more attention now that there are fewer nurses and COVID patients are in

the hospitals. One way to combat poor hand hygiene and make sure nurses and hospital staff are

performing hand hygiene is electronic hand hygiene monitoring with prompting devices. Having

a device like this can help nurses be more on top of performing hand hygiene and can help

prevent the spread of infection from one patient to another or from the patient to the nurse.

Electronic hand hygiene monitors are already being used in some hospitals and are

currently in use at Bayhealth hospital. The monitors, by Ecolab, are small and can be attached to

a badge reel. The sensor inside of the monitor connects with the sensors inside of the hand

sanitizers or hand soap dispensers. When the sanitizers/soaps are used the light on the monitor
turns green. If the nurse has not performed hand hygiene in a while the monitor will start

beeping and the light color will change to yellow, alerting the nurse that they need to perform

hand hygiene. The hospital itself sets a zone in each patient’s room. When the nurse steps into

that zone without using hand sanitizer, the badge will turn different colors. When the nurse goes

into a patient’s room and does not use hand sanitizer, the monitor beeps and turns yellow. When

the nurse goes into the zone by the patient’s bed and still has not used hand sanitizer, the light on

the monitor will turn red and beep, as well. This also goes for when the nurse leaves a patient’s

room. If the nurse steps out and does not perform hand hygiene, the monitor will beep and turn

yellow. After a period of time still without hand hygiene, the monitor will beep and turn red.

Each time the monitor changes colors or comes into contact with one of the sensors on the

dispensers, the information is sent to Ecolab and a compliance report is formed and sent to the

nurse each week. From this compliance report, the nurse can see what their compliance

percentage is, which they are given a grade for, and what the total percentage of compliance on

their unit is. This report is sent out to make the nurse aware of how compliant they are with

using hand hygiene and shows how they can improve their hand hygiene practices. Using hand

hygiene monitoring can help hospitals as a whole better their hand hygiene practices and protect

patients.

There have been some studies done on hospitals that use hand hygiene monitors and they

have shown that when using these monitors hand hygiene compliance has improved. In one

study published by the Journal of Infection Prevention, they studied healthcare workers in a

hospital setting. “Hand hygiene compliance was in the range of 98-100% during installation and

while using the monitors. Once the system was removed, hand hygiene compliance fell to pre-

installation levels (73%) according to gel usage” (Dyson, Madeo, para. 34). In this hospital
specifically, the rate of compliance improved significantly when the monitors were being used.

Another study done shows that employees were compliant, but this study believes, “hand

hygiene and low-level disinfection compliance is dependent on several personal and nonpersonal

factors. Issues such as time constraints, peer pressure, work culture, available resources, and

understanding of guidelines could influence staff behavior” (Akram, Washburn, para. 39). This

study shows more of a downfall of the monitoring system because not only is hand hygiene

dependent on the person themselves, but also hospital policies and other co-workers. That shows

the one downside to the monitoring system.

As said before, the nurse-to-patient ratio has been high, specifically recently, with some

nurses on Med-Surg floors having 6-7 patients in one shift. Between giving medications, giving

patient care, and everything in between, it is possible that the nurse will forget to perform hand

hygiene in between. One downfall of the electronic monitors is the range of them. When the

monitors first came out at Bayhealth, they did not have a good range, meaning unless the nurse

was right in front of the monitor when they used the dispenser, the monitor would not pick up on

the sensor causing the monitor to turn yellow/red when hand hygiene was actually performed.

This led to unnecessary lower compliance reports and to employees getting annoyed at the

monitors. Some medical staff took them off and did not use them properly because they did not

feel that they were working properly. Since then, the complaints about the monitors were told to

the managers on the floors and they were relayed to the people in charge of the monitors. They

have since given new monitors to employees with a better range of the sensors. Now when the

nurse is at the nurse server and they use the hand sanitizer dispenser, they do not have to hold

their badge up to the sensor, it already detects the monitor, and it is recorded as such. Overall,
there has been no research found that has had any major negative downsides to electronic hand

hygiene monitoring.

All hospitals should use this monitoring system because it improves the hand hygiene

compliance rates. Although some healthcare professionals might think this monitoring and the

beeping the monitor makes is annoying, this helps remind the person to wash/sanitize their hands

which prevents the spread of disease to the patients and also to themselves. From the research

found and the personal experience with these monitors, they should be used in all hospitals as a

safety measure because everyone could use a little help bettering their hand hygiene practices.
References

Andrews-Paul, A., Akram, H., & Washburn, R. (2020, June 5). Assessing Hand Hygiene and

Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed

Methods Approach. JMIR Nursing. Retrieved December 1, 2021, from

https://nursing.jmir.org/2020/1/e18788

Dyson, J., & Madeo, M. (2017, July 4). Investigating the use of an electronic hand hygiene

monitoring and prompt device: influence and acceptability. NCBI. Retrieved December

1, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761932/


Workflow Before Implementation
Workflow After Implementation

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