An Alabama hospital greatly improved hand hygiene compliance and significantly reduced healthcare-associated infections (HAIs) after installing an automated hand-hygiene monitoring system.

“One surgical intensive care unit (ICU) kept raising the bar, and they’re at 100% compliance,” says Brenda Brazzell, RN, BS, lead author of the study and the former manager of infection control and employee health at Princeton Baptist Medical Center in Birmingham, AL.1

On most units that used the electronic monitoring technology, hand hygiene compliance doubled. Some areas achieved especially high rates of hand hygiene compliance, she says.

The surgical ICU achieved the optimal compliance rate due in part to a champion — a nurse manager who demanded hand hygiene compliance, Brazzell notes.

“She would say, ‘If you are going to work here, do hand hygiene,’” she says.

The hospital’s automated system involves hand sanitizer and soap dispensers that contain radio frequency identification (RFID) electronic devices. Nurses and other patient care staff, including patient care assistants, unit clerks, radiology techs, respiratory therapists, and phlebotomists, wear neck badges that connect electronically with the dispensers.

“When they walk up to a hand sanitizer dispenser — which is between every patient’s room — they stand in front of it, fully push the dispenser, and it recognizes the dispenser, and it recognizes the employee,” Brazzell explains.

The dispensers have small screens that give information about the weather and tips related to patient care and infection control.

“It has whatever information we want included,” Brazzell says.

The goal is to help staff create the habit of hand sanitizing within 30 seconds of entering a patient’s room and immediately upon exiting.

“If you have gloves, you remove the gloves, wash hands with soap and water, and you do this before you leave the room,” Brazzell says.

The computerized system collects information about hand hygiene compliance, which managers can use to identify obstacles.

The system could send alerts to pagers or phones when a worker fails to comply, but the hospital chose not to do this because the goal was to encourage and use positive reinforcement.

“We didn’t want to be the big brother looking over their shoulders,” Brazzell explains. “We wanted the information so we could ask them, ‘Can you tell me what obstacles prevented you from doing hand hygiene in these episodes?’”

Data collected about individual and unit hand hygiene compliance was used to fix obstacles and improve compliance.

They found that some employees were too short to be recognized by the devices’ monitors. Other times, workers would say their badge wasn’t working, but instead of calling for help as they were instructed to do, they let it go. Another problem was having a low battery.

“We had some technical errors and had the company come out to fix these,” Brazzell says. “Our facilities engineer can fix most wiring problems.”

One of the hospital’s compliance strategies was to create hand hygiene behavior change through the electronic system, reinforcing positive behavior through incentives such as scheduling benefits.

“We give staff compliant in hand hygiene an extra weekend off,” Brazzell says. “If you are in the excellent category of compliance then you might get an extra weekend off during a six-week period.”

This compliance could not be achieved by entering a room once and doing it correctly.

“There had to be a certain number of episodes of entry and exit in order to qualify,” she explains.

Another layer to the compliance efforts was monitoring by a prevention liaison team, Brazzell says.

“They monitored without the staff knowing someone was observing their hand hygiene,” she says. Observation was also done in hospital areas that do not have the hand hygiene technology.

“Not all units have adopted it, but the units that did saw their compliance skyrocket,” Brazzell says. 


1. Brazzell BD. Improving high hand-hygiene compliance and reducing healthcare-associated infection in eight nursing units. AJIC. 2014;42(6):S25-S26