Clinical experiences with a new system for automated hand hygiene monitoring: A prospective observational study

Am J Infect Control. 2020 May;48(5):527-533. doi: 10.1016/j.ajic.2019.09.003. Epub 2019 Oct 18.


Background: Hand hygiene compliance (HHC) among health care workers remains suboptimal, and good monitoring systems are lacking. We aimed to evaluate HHC using an automated monitoring system.

Methods: A prospective, observational study was conducted at 2 Danish university hospitals employing a new monitoring system (Sani nudge). Sensors were located on alcohol-based sanitizers, health care worker name tags, and patient beds measuring hand hygiene opportunities and sanitations.

Results: In total, 42 nurses were included with an average HHC of 52% and 36% in hospitals A and B, respectively. HHC was lowest in patient rooms (hospital A: 45%; hospital B: 29%) and highest in staff toilets (hospital A: 72%; hospital B: 91%). Nurses sanitized after patient contact more often than before, and sanitizers located closest to room exits and in hallways were used most frequently. There was no association found between HHC level and the number of beds in patient rooms. The HHC level of each nurse was consistent over time, and showed a positive correlation between the number of sanitations and HHC levels (hospital A: r = 0.69; hospital B: r = 0.58).

Conclusions: The Sani nudge system can be used to monitor HHC at individual and group levels, which increases the understanding of compliance behavior.

Keywords: Compliance; Electronic monitoring; Hand hygiene; Health care-acquired; Infection control; Infection prevention.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior Observation Techniques / methods
  • Behavior Observation Techniques / statistics & numerical data*
  • Cross Infection / prevention & control
  • Denmark
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Hand Hygiene / methods
  • Hand Hygiene / standards
  • Hand Hygiene / statistics & numerical data*
  • Hospitals, University
  • Humans
  • Infection Control / methods
  • Infection Control / standards
  • Infection Control / statistics & numerical data*
  • Male
  • Nursing Staff, Hospital / standards
  • Nursing Staff, Hospital / statistics & numerical data*
  • Prospective Studies