Rapid phase I evaluation of a novel automated hand hygiene monitoring system in response to COVID-19

© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Direct observation (DO) of hand hygiene (HH) behaviour remains the gold standard tool for measuring staff compliance during the COVID19 pandemic. However, gathering HH data in the current environment may be challenging for many healthcare facilities due to resources being diverted to COVID19 containment measures. Hence, audit on HH compliance may be severely compromised due to lack of labour force to perform DO. This is problematic as hospital transmission of COVID19 is high. Automated hand hygiene monitoring systems (AHHMS) have been developed in recent years to enable healthcare organisations to gather robust HH data with minimal investment of labour. Group monitoring systems and badgebased systems are the two most common types of AHHMS available in the marketplace. Group monitoring systems track usage of HH dispensers to give an idea of HH frequency by staff groups. Badgebased systems typically require healthcare workers (HCWs) to wear an additional tracking device that communicates with dispenserbased sensors. Hospitals with AHHMS already in place prior to the COVID19 pandemic are in an advantageous position. An AHHMS was used to capture 35 million HH opportunities between January and May 2020 at the height of the pandemic. Capturing a similar number of HH opportunities via DO would not be feasible. Makhni et al used the same AHHMS to demonstrate that in the early days of the pandemic, HH compliance reached 100%, although unfortunately it did decline to 51.8% within a few months. AHHMS which purport to measure HH compliance rates are typically USbased and are reliant on healthcare institutions having a high proportion of singlepatient rooms. These AHHMS focus on single room entries and exits as surrogates for WHO HH moments 1 and 4, that is, washing hands before and after patient contact. Such an approach contributes to a limited picture of true HH behaviour. After an extensive consultation exercise with NHS HCWs, the concept of a novel AHHMS, ‘Hygenie’, has evolved. The end result of any HH initiative is to prevent healthcareassociated infections (HCAIs) and improve patient safety. Simply encouraging HCWs to perform HH more often could be a simpler improvement initiative for HCWs to work Summary box