JMIR Publications

ABSTRACT

Background:

Healthcare-associated infections (HAIs) remain a significant challenge for healthcare facilities worldwide, contributing to patient morbidity, mortality, and substantial economic burden. In the United States alone, the Centers for Disease Control and Prevention (CDC) estimates approximately 1 in 31 hospitalized patients acquires at least one HAI during their stay, resulting in billions of dollars in preventable healthcare costs annually [1]. Despite longstanding evidence-based guidance on infection prevention, sustained improvements in infection rates have been difficult to achieve across diverse healthcare settings. Electronic hand hygiene monitoring (EHHM) systems offer a promising approach to enhancing adherence to infection prevention protocols while providing robust data for operational decision-making. By delivering real-time feedback to healthcare workers and tracking performance at the unit and facility level, these systems can identify and correct lapses in hand hygiene behavior, a primary contributor to HAIs [2]. Prior studies demonstrated that automated monitoring has improved compliance and reduced infection rates, though long-term, multi-facility analyses remain limited [3].

Objective:

This analysis evaluates HAI performance among 25 client facilities of BioVigil Technologies, an EHHM vendor based in Ann Arbor, Michigan. This study uses publicly reported CMS data, assessing both infection outcomes and operational impact. By comparing pre- and post-implementation periods, we aim to quantify the clinical and economic benefits of EHHM across a variety of hospital types and sizes, providing insight into strategies for infection prevention improvement.

Methods:

Facilities were included if they met three predefined criteria: BioVigil’s EHHM implementation must have occurred in 2023 or earlier; CMS publicly reported HAI data had to be complete for both the 2024 calendar year and the year immediately preceding implementation; and CMS HAI reporting had to be available at the individual facility level. These criteria yielded a final study population of 25 healthcare facilities. The facilities included 16 short-term acute care (STAC) hospitals, one long-term acute care (LTAC) hospital, seven critical access hospitals, and one VA hospital, collectively comprising 4,198 beds and 284 clinical units. CMS-reported HAIs for STAC hospitals included CAUTI, CLABSI, MRSA, SSI, and CDI; LTAC, critical access, and VA hospitals reported CAUTI, CLABSI, and CDI. Earliest full EHHM implementation occurred in 2016 (two facilities) and most recent in 2023 (three facilities). This retrospective, observational analysis evaluated HAI outcomes aggregated at the hospital level. Percent change from baseline to 2024 was calculated for each facility and across the study population. Descriptive statistics, including mean, median, and 95% confidence intervals, characterized sustained changes in infection counts. EHHM operational data from 2024 were also analyzed to quantify hand hygiene opportunities, real-time corrective reminders, and overall compliance rates. All data were derived from publicly available CMS reports and de-identified operational records; no patient-level data was used.

Results:

In 2024, BioVigil’s EHHM system captured 67,663,570 hand hygiene opportunities across all 25 facilities. During this period, 1,112,148 potential cross-contamination events were corrected in real time through badge-based reminders. This contributed to an average hand hygiene compliance rate of 91.25% across the study population. Of the 25 facilities, 22 demonstrated reductions in total HAI counts compared to their pre-implementation baseline. Four facilities achieved net-zero HAIs in 2024, representing a 100% reduction. One facility exhibited no change, and two experienced minimal increases of two and four cases, respectively — both from unusually low baseline years that likely underrepresent each facility’s true pre-EHHM infection burden. Across all 25 facilities, the mean sustained HAI reduction was 46.95% (95% CI 35.5–58.4%), closely aligning with the median of 50%. Among the 22 improving facilities, the mean reduction was 56.25% (95% CI 43.2–69.3%) with a median of 55.13%, collectively representing 300 fewer CMS-reported HAI cases in 2024. Using a conservative average direct cost of $29,412 per HAI case [4], this reduction corresponds to an estimated $8.82 million in avoided costs. This estimate excludes extended length of stay, readmissions, and CMS value-based purchasing penalties, meaning the true economic benefit is likely substantially greater. Operational efficiencies were also observed: 16 of 25 facilities reported hand hygiene data to The Leapfrog Group. Had these facilities relied exclusively on manual observation, an estimated 136,620 staff hours and approximately $5.74 million in associated labor costs would have been required in 2024 [5]. Together, these findings highlight the combined clinical and operational value of automated hand hygiene monitoring at scale.

Conclusions:

In conclusion, this analysis highlights that the majority of BioVigil Technologies’ clients experienced noticeable HAI reductions in 2024 compared to pre-implementation performance, regardless of system use duration. These outcomes suggest that electronic hand hygiene monitoring represents an effective, sustainable, and data-driven strategy to support infection prevention programs, improve patient safety, and enhance healthcare system efficiency. Continued adoption of scalable monitoring technologies may play an important role in advancing sustained infection prevention performance across diverse healthcare settings. Clinical Trial: Electronic hand hygiene monitoring; Infection Reduction; Clinical outcomes