Comparison of human and electronic observation for the measurement of compliance with hand hygiene

Am J Infect Control. 2014 Nov;42(11):1188-92. doi: 10.1016/j.ajic.2014.07.031. Epub 2014 Sep 16.


Background: Monitoring of hand hygiene is an important part of the improvement of hospital quality indicators.

Methods: This study was prospectively performed over a 14-week (electronic observer) period from December 3, 2013-March 9, 2014, to evaluate hand hygiene compliance in an adult step-down unit. We compared electronic handwash counters with the application of radiofrequency identification (RFID - ZigBee; i-Healthsys, São Carlos, Brazil) (electronic observer), which counts each activation of the alcohol gel dispenser to direct observation (human observer) using the iScrub application.

Results: For the overall time period of simultaneous electronic and human observation, we found that the electronic observer identified 414 hand hygiene episodes, whereas the human observers identified 448 episodes. Therefore, we found 92% (95% confidence interval [CI], 90%-95%) overall concordance (414/448), with an intraclass correlation coefficient of .87 (95% CI, 0.77-0.92).

Conclusion: Our RFID (ZigBee) system showed good accuracy (92%) and is a useful method to monitor hand hygiene compliance.

Keywords: Hand hygiene monitor; Handwash; Hawthorne effect; Radiofrequency identification; Zigbee.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brazil
  • Epidemiological Monitoring*
  • Guideline Adherence / standards*
  • Guideline Adherence / statistics & numerical data*
  • Hand Hygiene / standards*
  • Hand Hygiene / statistics & numerical data*
  • Humans
  • Prospective Studies