Improving hand hygiene in hospitals: A comparative study using body-worn cameras and direct observation.

Background: Hand hygiene (HH) prevents infections, but traditional monitoring is limited by office hours and the Hawthorne effect. We used body-worn cameras in ICU to compare video with direct observation.

Methods: After ethics approval, staff wore a GoPro™ on the upper abdomen during patient care. A trained observer simultaneously documented opportunities and performance. A blinded researcher analyzed the video. Both methods were compared on opportunities, compliance, performance, and duration.

Results: Seventeen paired video and observer data sets captured 166 HH opportunities and 147 events. Of these, 118/147 (80%) were in response to a HH opportunity and 29/147 not (20%). Including HH performance-related to events, overall HH compliance was 71%. Both methods identified 80% of opportunities. Video detected 11.5% of missed opportunities, while the observer identified 8.5% missed by video. Mean duration was comparable (11.3±9.2 sec vs. 12.0±9.8 sec, p=0.55).

Discussion: Body-worn cameras effectively identified HH opportunities, performance, and duration, capturing events missed by observers ~20% of the time. However, video analysis had flaws, revealing missed events upon review. Observer data, long considered the gold-standard, showed only 80% accuracy.

Conclusions: Body-worn cameras are a feasible tool for HH monitoring, but are labor-intensive. Automating video analysis could enhance feasibility for routine use.