JMIR Publications

ABSTRACT

Background:

Hand hygiene is one of the most effective ways to prevent Healthcare-Associated Infections (HAIs) and reduce their transmission. Due to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into Healthcare Workers (HCWs)’ daily routines to measure their hand hygiene compliance and quality.

Objective:

This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss these systems’ capabilities and limitations.

Methods:

A systematic search of PubMed, IEEE Xplore Digital Library, and ACM Digital Library is performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies are initially screened and assessed independently by the two authors, and disagreements between them are further summarized and resolved by discussion with the senior author.

Results:

In total, 1035 publications were retrieved by the search queries, and 89 articles fulfilled the eligibility criteria and were retained for review. By summarizing the included studies, 73 studies used electronic monitoring system to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7%), camera-assisted observation (10/73, 14%), sensor-assisted observation (29/73, 40%), and Real-time Locating System (RTLS) (32/73, 44%). 21 studies evaluate hand hygiene quality, consisting of compliance with World Health Organization (WHO) 6-step hand hygiene techniques (14/21, 67%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33%).

Conclusions:

Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, and associated costs as well as infrastructure improvements. Moreover, this review finds that standardized measurement tools to evaluate system performance are lacking, and thus, future research is needed to establish standardized metrics to measure system performance differences between electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation in order to improve system performance and address other hand hygiene-related issues.