Light-guided nudging and data-driven performance feedback improve hand hygiene compliance among nurses and doctors

Am J Infect Control. 2021 Jun;49(6):733-739. doi: 10.1016/j.ajic.2020.11.007. Epub 2020 Nov 10.


Background: Evidence-based practices to increase hand hygiene compliance (HHC) among health care workers are warranted. We aimed to investigate the effect of a multimodal strategy on HHC.

Methods: During this 14-month prospective, observational study, an automated monitoring system was implemented in a 29-bed surgical ward. Hand hygiene opportunities and alcohol-based hand rubbing events were measured in patient and working rooms (medication, utility, storerooms, toilets). We compared baseline HHC of health care workers across periods with light-guided nudging from sensors on dispensers and data-driven performance feedback (multimodal strategy) using the Student's t test.

Results: The doctors (n = 10) significantly increased their HHC in patient rooms (16% vs 42%, P< .0001) and working rooms (24% vs 78%, P= .0006) when using the multimodal strategy. The nurses (n = 26) also increased their HHC significantly from baseline in both patient rooms (27% vs 43%, P = .0005) and working rooms (39% vs 64%, P< .0001). The nurses (n = 9), who subsequently received individual performance feedback, further increased HHC, compared with the period when they received group performance feedback (patient rooms: 43% vs 55%, P< .0001 and working rooms: 64% vs 80%, P< .0001).

Conclusions: HHC of doctors and nurses can be significantly improved with light-guided nudging and data-driven performance feedback using an automated hand hygiene system.

Keywords: Adherence; Electronic monitoring; Health care-acquired; Infection prevention; Surveillance.

Publication types

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

MeSH terms

  • Cross Infection* / prevention & control
  • Feedback
  • Guideline Adherence
  • Hand Disinfection
  • Hand Hygiene*
  • Humans
  • Nurses*
  • Prospective Studies