Defining the configuration of a hand hygiene monitoring system

Background: Inadequate hand hygiene (HH) by staff leads to hospital-acquired infections, high morbidity, and mortality rates for patients and a growing economic impact. The Toronto Rehabilitation Institute developed a different approach to measure and increase HH frequency, that is, a monitoring system that automatically detects HH opportunities associated with approaching and leaving patient areas. The aim of this study was to collect and classify data on HH opportunities to (1) evaluate the percentage of opportunities that the system could detect and (2) identify the system configuration. Methods: An observational study collected time-stamped data on HH opportunities and methods of nurses on a complex care unit. Data were processed according to the Ministry of Health of Ontario, Canada. The data were subsequently classified corresponding to the motion patterns of nurses to identify areas that need to be controlled by the system. Results: A total of 1093 HH opportunities were recorded over 94 hours from 15 nurses, with 919 opportunities associated with entering or leaving patient environments. Conclusion: The monitoring system would be able to detect and process 85% of HH opportunities in a complex care setting. To process these opportunities, the system configuration should include monitoring of patient room entrances, individual patient environments in multibed rooms, and shared ensuite bathrooms.