Hand-Hygiene Compliance

Our technology enables the best-in-class monitoring  solutions for infection control and hand hygiene systems, providing a cost-effective means to automatically capture compliance and noncompliance events 24/7.

Poor hand hygiene in hospitals and medical care facilities is associated with increased risk of infection and death of patients. Patient safety is a priority, and improving hand hygiene compliance systems in healthcare is an easy way to reduce the risk of patients and staff being exposed to or contracting an infectious disease.

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What Is Hand Hygiene Compliance?

Hand hygiene involves disinfecting hands with either alcohol or soap and water to prevent the spread of infectious disease. Healthcare facilities are at high risk for spreading infections and since the role of hand hygiene in reducing unnecessary infections was discovered, health organizations have attempted to incorporate a protocol to improve hand-washing standards.

For example, the World Health Organization (WHO) developed a hand hygiene protocol to help reduce unnecessary infection. According to WHO recommendations, healthcare workers should perform hand hygiene:

  • After contacting body fluids
  • Before patient contact
  • After removing gloves
  • Before invasive procedures
  • Before an aseptic task
  • After patient contact

The issue of compliance comes down to training, motivating and reinforcing appropriate behaviors. Hospitals and medical centers must implement guidelines for hand hygiene systems and find a way to monitor and increase compliance.

The Importance of Hand Hygiene Compliance in Hospitals

A serious and avoidable threat to patient safety, healthcare associated infection (HAI) occurs when infections are contracted in a hospital or medical facility. The types of infections associated with hospitals and medical facilities can include blood stream infections, pneumonia and surgical site infections. Any patient is potentially susceptible to HAI, and it is not caused by their particular diagnosis.

HAI accounts for more than 700,000 unnecessary infections annually, while an average of 75,000 of those patients die during their hospital stay. On a daily basis, approximately one out of every 25 patients in a healthcare facility has a HAI, according to the CDC — an organization that is instrumental in monitoring and reducing these infections.

The cost to healthcare facilities in 2007 related to HAI was estimated at between $28.4 and $33.8 billion. The CDC did a thorough cost estimate report in 2009 that breaks down these numbers even further. The average annual per patient cost to a hospital or medical facility for all HAI in the CDC report was $18,581. The report also shows the possible savings from preventable infections. If 20% of infections were prevented, the cost savings would be between $5.7 and $6.8 billion. A 50% prevention rate would save between $14.2 and $16.9 billion, and if 70% of the infections were prevented, the savings would be between $19.9 and $23.7 billion. With the cost savings of preventing just 20% of HAIs, a hospital could treat many of its other patients who entered the facility with an illness borne outside the premises.

Adding to the staggering cost impact of HAIs in healthcare, the Centers for Medicare and Medicaid Services (CMS) are no longer reimbursing payments for infections acquired during the patient’s hospital stay. This change has been put in place in an effort to minimize the number of HAI cases by incentivizing the improvement of hospital care. In addition, under the Affordable Care Act (ACA), the worst performing hospitals are penalized, reducing their payments by 1%.

hand hygiene compliance
hand hygiene compliance monitoring

Hand Hygiene Compliance Monitoring in Health Care

Monitoring hand hygiene compliance can take several different forms. Having trained monitors manually observe and report hand hygiene activities was once considered the gold standard. However, manual direct observation is labor intensive, expensive, and only accounts for 1.2% to 3.5% of all hand hygiene events. Additionally, the most significant disadvantage is the potential to influence the behavior of those who know they are being observed. This is known as, the Hawthorne Effect and has been proven to cause Hand Hygiene Compliance rates to be overstated by up to 300%. Measuring the amount of product consumed for hand hygiene could also reveal increases or decreases in compliance. However, this is not contextually specific and is unable to account for things like spillage or family usage, etc.  Surveying patients for their observations of hand hygiene practices during their healthcare experience is another way to collect this data but inaccurate recall is often an issue. Finally, electronic compliance monitoring systems that have the ability to accurately measure 100% of hand-hygiene events like CenTrak’s RTLS can be employed. Electronic monitoring systems are the most effective and only passive method for increasing hand hygiene compliance. It does not take additional time out of an already busy healthcare worker’s day, and it is not subject to human error or manipulation.


  • Generate reports that show visits to hand hygiene stations as well as missed opportunities. Reports can be compared and analyzed to help determine where additional interventions are needed.
  • Personal reminders to staff to encourage compliance in real-time. The best behavior correction strategy is delivered immediately. A gentle reminder from the system at the exact moment when compliance could be improved can provide faster results than other methods.
  • Easily installed and integrated battery powered Dispenser Monitors. Integrated dispenser monitors are hidden from the view of the healthcare worker, measuring true unbiased compliance.
  • Mounts to any dispenser, canister, pump or sink. Hospital equipment can be expensive, so an electronic monitoring system that does not require swapping out existing fixtures saves money. No matter what style pumps and dispensers are already in place, monitors can be attached to them.
  • Improves clinical workflow. An electronic hand hygiene monitoring system does not interfere with workflow the way other types of monitoring might. In fact, because it does not require the healthcare worker to do anything to record compliance, it actually improves workflow.

CenTrak’s electronic hand hygiene monitoring system is deployable as a standalone solution or as part of CenTrak’s Enterprise Location Services™. Being able to add just what you need means increased compliance quickly.  With a full RTLS implementation, true compliance rates are evaluated by reporting the number of dispenser interactions, as well as the total number of instances in which hand washing was needed. With this information, hospitals can audit the hand hygiene process, which reduces spread of infection, improves patient safety and lowers cost.

Studies suggest that electronic monitoring systems have both a short-term and long-term impact on hand hygiene compliance. In addition, they provide an objective, consistent and long-term means of collecting and reporting data.

Reasons for Non-Compliance

Unfortunately, healthcare workers often under-estimate the importance of hand hygiene and over-estimate their compliance. Hand hygiene compliance typically averages only 39%, according to a 2009 WHO report.  During the course of a busy day’s work at the hospital, many healthcare workers are potentially unaware of the number of times they miss an opportunity for hand hygiene.

There are several reasons why healthcare workers do not comply with hand hygiene, as a study by The Joint Commission revealed. Here are some of the reasons they came up with:

  • Workflow not conducive to hand hygiene
  • Data infrequently collected and reported
  • Forgot or distracted
  • Frequent room entry and exit required
  • Emergency situation
  • No reminder from other staff
  • Inadequate safety culture that does not emphasize compliance

The solution to many of these compliance issues is simple. In addition to a system that can provide proactive reminders and does not interrupt clinical workflow, consistent monitoring and reporting of hand hygiene activities is key. Effective monitoring and reporting are proven to increasing hand hygiene compliance and can be achieved through the use of CenTrak’s RTLS.

CenTrak’s hand-hygiene compliance system will allow you to spend less time with keyboards and more time with patients. The benefits of the system include:

  • Decrease time spent on data entry and compliance report building
  • Identify focal areas with the analysis tools
  • Improve data volume and quality
  • Match current processes with smart paper forms and paperless mobile tools
  • Gain new insights from importing existing data
  • Lessen the gap between manual and automated solutions
  • Collect data from remote clinics, partially equipped facilities and paper-based observations in one place
  • Benchmark with peers
  • Meet goals and measure progress

Learn More About Our Infection Control and Hand Hygiene Solutions

Our technology enables the best-in-class monitoring solutions for infection control and hand hygiene, providing cost-effective means to automatically capture compliance and noncompliance events, 24/7. Not quite ready for a facility-wide RTLS investment? Get started today with our simple hand hygiene compliance tools and grow into automated solutions when you are ready.

Contact us today to learn what CenTrak’s RTLS can do to improve your healthcare facility’s compliance with hand hygiene standards.