The Role of Autonomy in Electronic Hand Hygiene Monitoring Systems

Abstract

Proper hand hygiene (HH) is one of the most effective measures to prevent HAIs by minimizing the transmis-sion of pathogens. Reminder prompts have been demonstrated to play a significant role in improving HH compliance among healthcare workers (HCWs). Pre-vious studies have explored the efficacy of electronic hand hygiene monitoring systems (EHHMS) by enforc-ing uniform prompting protocols across all users. However, little is known about the effects of allowing HCWs to choose whether to activate or deactivate the prompting feature. This study investigates the impact of voluntary prompt deactivation on HH compliance rates in a Toronto hospital’s respiratory unit. A cohort of 23 HCWs was equipped with EHHMS badges and given the option to activate or deactivate the prompt. The badges delivered real-time prompting via discrete vibrations when HH is required upon entering or exiting patient areas. Over a 6-month period, their HH compliance rates were monitored. Compliance data were categorized into periods when the prompt was activated (Prompt-On) and deactivated (Prompt-Off), allowing for analysis of individual variability in prompt usage, as participants switched between activating and deactivat-ing the prompt at different times. The system automati-cally collected compliance data, which were then ana-lyzed using Wilcoxon signed-rank tests due to the non-normal distribution of the two groups. A total of 58,060 HH opportunities were recorded. The study revealed a significant difference in HH com-pliance rates between the Prompt-On and Prompt-Off groups (P<0.0001). Participants in the Prompt-On group demonstrated a mean compliance rate of 85% ± 16%, significantly higher than the Prompt-Off group, which had a mean compliance rate of 58% ± 25%, sug-gesting the critical role of real-time feedback in main-taining HH adherence. The findings of this study align with prior research emphasizing the importance of reminder prompts in enhancing HH compliance. Unlike previous studies, which applied uniform prompting protocols, this investi-gation highlights the detrimental effects of allowing HCWs to opt out of prompting [3]. The autonomy to deactivate prompts appears to undermine the overall effectiveness of EHHMS, leading to lower compliance rates and potentially increasing the risk of HAIs.