Wearable Device Does Not Change Hand Hygiene Compliance Among Healthcare Workers

The use of an electronic wearable device did not change hand hygiene compliance among healthcare workers, according to the findings of a new study.

Still, the technology increased the duration of hand rubbing and the volume of alcohol-based handrub used by healthcare workers.

The findings suggested the technology must be further developed and tested.

Daniela Pires, M.D., Ph.D., and colleagues determined whether providing real-time feedback on a simplified hand hygiene action would improve compliance with the World Health Organization’s “5 Moments” and the quality of the hand hygiene action. The open-label, cluster randomized, stepped-wedge clinical trial took place between June 1, 2017 and Jan. 6, 2018. The trial took place in a geriatric hospital of the University of Geneva Hospitals in Sweden. Of those eligible, 97 healthcare workers volunteered to wear a novel electronic wearable device that delivered real-time feedback on hand rubbing duration and application of a hand-sized customized volume of alcohol-based handrub.

The device, dubbed SmartRub, consisted of two elements: a bottle and a wristband. Individual alcohol-based handrub bottle was equipped during the transition and intervention periods with a volumetric flow meter that measured the volume of alcohol-based handrub poured onto the hands. It also provided feedback by vibrating as soon as the predefined volume was applied. The wristband measured the duration of each hand hygiene action and, during the intervention period, vibrated after 15 seconds independently of the hand rubbing duration performed by the healthcare worker.

The study consisted of a baseline, transition, and intervention period. Participants did not wear the device at baseline. The device was worn during the transition period, but the feedback mode (vibration) was not activated, though the device actively monitored the volume of alcohol-based handrub and duration of hand friction for each hand hygiene action. During the intervention period, the feedback mode was activated and monitoring of practices continued. The technology was not worn during the follow-up period.

Hand hygiene compliance was the primary outcome of the study. Additional outcomes included volume of alcohol-based handrub and duration of hand rubbing for each hand hygiene action, along with adherence to device use and frequency of hand hygiene.

Overall, 12 healthcare workers did not fully complete the intervention but were included in the analysis. Nearly 6,900 hand hygiene opportunities were observed during 759 observation sessions. At intervention, hand hygiene compliance (62.9%; 95% CI, 61.1-64.7) was lower than at baseline (66.6%; 95% CI, 64.8-68.4). Hand hygiene compliance was not different between study periods (OR, 1.03; 95% CI, .75-1.42; P = .85). Factors independently associated with reduced hand hygiene compliance included days since study onset (.997; 95% CI, .994-.998; P <.001), older age (OR, .97; 95% CI, .95-.99; P = .015), and workload (OR, .29; 95% CI, .2-.41; P <.001).

The median volume of alcohol-based handrub and duration of hand rubbing in transition and intervention periods increased from 1.12 (.76-1.68) mL to 1.71 (1.01-2.76) mL and from 6.5 (4.5-10.5) seconds to 8 (4.5-15.5) seconds.

The overall sensitivity of the wearable was 94.1% (95% CI, 91.4-96.2) and the specificity was 99% (95% CI, 97.5-99.7).

The study, “Effect of Wearing a Novel Electronic Wearable Device on Hand Hygiene Compliance Among Health Care Workers,” was published online in JAMA Network Open.