Hand hygiene: Electronic monitoring tools just one element of compliance plans

Electronic monitoring tools may help promote hand-hygiene compliance, but ensuring that the habit sticks will require leaders to fully commit to enforcement, a study has found.

Though proper hand hygiene is considered essential to avoid the spread of infectious diseases, close to a quarter of hospitals fail to meet all best practices, FierceHealthcare previously reported.

The research team, whose findings were published in Management Science, put radio frequency identification-based systems in 42 hospitals and monitored the hand-hygiene habits of more than 5,200 caregivers over the course of three years. On average, the studied healthcare professionals largely increased hand-hygiene compliance under the electronic monitoring at first, but it gradually declined after two years.

When the electronic monitoring tools were removed, the team found that hand-washing rates went down, so no hand-hygiene habits were truly formed. The compliance rates actually dropped below those seen before the electronic tools were in place, the study found.

"While we thought decreased compliance after the monitoring could perhaps be a possible outcome, we were still somewhat surprised to see the result," said Hengchen Dai, assistant professor of organizational behavior at Olin Business School at Washington University in St. Louis and one of the study authors, in the study announcement. "We based our prediction on past research about 'crowding out,' whereby caregivers' internal motivation for compliance may have been replaced by external forces associated with monitoring, such as the fear of penalties or punishments for not washing their hands."

Dai said in the announcement that the findings show that electronic monitoring tools are just one potential piece of a larger plan to promote hand hygiene. Changing workplace culture and norms through leadership is also necessary, she said. "Managers should not 'monitor and forget,' " Dai said.

To learn more:
- read the study abstract
- here's the study announcement

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