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that kind of research,” Longtin remarked.“ That lends itself to a lot of potential bias and threats to validity. Gould and colleagues thought that these systems could increase compliance potentially, but their impact on actually preventing healthcare-acquired infections is unclear.”
Longtin proposed the idea that these electronic systems could be“ taught to do new tricks,” he said, adding,“ Could these systems do what direct observation cannot do at the moment? I can think of two examples of what the future may hold; the first is identifying the chronic underperformers related to hand hygiene compliance. When you measure 70 percent compliance on a ward, it’ s not that every healthcare worker is at 70 percent compliance-- some are at 100 percent while some are probably at 20 percent. So, who are these chronic underperformers? They are under the radar with direct observation, as it’ s almost impossible to find the healthcare workers who never perform hand hygiene. Some systems show us there’ s a wide range in compliance; an electronic system could allow you to identify those who are dragging down the compliance rates. It could also identify the high performers in hand hygiene by using an anonymous system, where workers don’ t wear badges, but you can still tease out the relative performance of nurses, for example.
There are many ways to assess hand hygiene compliance, but none of them is perfect. Should we still continue to perform direct monitoring using discreet observers? I think yes, it is still the gold standard, and electronic systems cannot currently replace direct observation, it will most likely be a gradual process, but we’ ll need to find potential uses for new systems that provide us with data that the current gold standard cannot provide.”— Dr. Yves Longtin
If you combine the electronic monitoring database with the nurse assignment sheet, you can know which nurse oversaw which room. So, if you track them day after day for months, as well as inversely, you can identify nurses that whenever they oversee a room, the compliance increases. And identify other nurses when their compliance decreases compared to their peers. We haven’ t tested whether a method like this could work but I think it’ s very promising.”
Longtin continued,“ A second potential functionality of these electronic systems is to tap into their capacity to detect potential outbreaks.
He pointed to the study by Kovacs-Litman, et al.( 2021) who performed a controlled, interrupted time series across five acute-care academic hospitals using group electronic monitoring. This system captures 100 percent of all hand sanitizer and soap dispenser activations via a wireless signal to a wireless hub; the number of activations is divided by a previously validated estimate of the number of daily hand hygiene opportunities per patient bed, multiplied by the hourly census of patients on the unit.
Daily hand hygiene adherence 60 days prior and 90 days following outbreaks on inpatient units was compared to control units not in outbreaks over the same period, using a Poisson regression model adjusting for correlations within hospitals and units. Predictors of hand hygiene improvement were assessed in this multivariate model. In the 60 days prior to outbreaks, units destined for outbreaks had significantly lower hand hygiene adherence compared to control
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nov-dec 2025 • www. healthcarehygienemagazine. com •
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