Critically ill patients are at increased risk of healthcare associated infection where hand hygiene (HH) is a routine practice known to decrease this risk. We validated the use of a group electronic hand hygiene monitoring system (GEHHMS) across 20 critical care units, which was subsequently implemented in 24 critical care units across 12 hospitals. Real-time feedback to units resulted in 28% relative improvement within 2-months of implementation. When the COVID-19 pandemic was declared, we found that the start of the COVID-19 pandemic was associated HH rates that improved to nearly 80% across both wards and critical care units. These findings provided further validation of GEHHMS given that high-levels of HH adherence were achievable using this system. Ontario Health Quality now recognizes GEHHMS for measurement of HH performance to meet public reporting requirements, which should encourage additional adoption of this technology across Ontario hospitals.

Objectives: Critically ill patients are at increased risk of healthcare associated infection where hand hygiene (HH) is a routine practice known to decrease this risk. This study sought to validate the use of group electronic hand hygiene monitoring systems (GEHHMS) as a method of more accurately measuring HH in critical care units.

Methods: We performed a multicentre validation study that included 20 critical care units across 10 Ontario hospitals to understand the predictors of variability in HH opportunities and derive benchmarks for using GEHHMS in different types of critical care units.

Results: Over 2,812 hours of observation were performed that identified 25,417 HH opportunities with significant variability based on the time of day, day of the week, unit acuity, patient acuity, patient population and use of additional precautions. A multivariable analysis was used to derive the daily predicted HH opportunities used by the GEHHMS to determine the daily unit HH adherence. GEHHMS was implemented across 2 additional hospitals for a total of 24 critical care units across 12 Ontario hospitals. At baseline, HH adherence was 30.0% (1,084,329 of 3,614,908). Real-time feedback to units resulted in 28% relative improvement within 2-months (HH adherence of 38.5%; 740,660 of 1,921,656).

Challenges: The improvement study ended prematurely due to the COVID-19 pandemic, but the GEHHMS was used during the first pandemic wave across these 12 hospitals. A second study showed that the start of the COVID-19 pandemic was associated with rapid HH improvement to nearly 80% adherence across all wards (n=31) and critical care units (n=20).

Conclusion: Both the validation and implementation study and our experience during the COVID-19 pandemic demonstrated that the achievable opportunity for HH improvement in critical care. Ontario Health Quality now recognizes GEHHMS for measurement of HH performance, which should encourage broader adoption of this technology.

1. Leis JA, Obaidallah M, Williams V, Muller MP, Powis JE, et al. Validation and implementation of group electronic hand hygiene monitoring across twenty-four critical care units. Infection Control & Hospital Epidemiology, 2022; Vol 43, Issue 7, pp 834-39. doi:10.1017/ice.2021.250

2. Williams V, Kovacs-Litman A, Muller MP, Hota S, Powis JE, Mertz D, et al. Impact of COVID-19 on hospital hand hygiene performance: a multicentre observational study using group electronic monitoring. CMAJ Open, 2021;(4) E1175-E1180. doi:10.9778/cmajo.20210072