Improving the hand hygiene of healthcare workers: Exploring the feasibility of an electronic monitoring system

Abstract

Technical innovations, such as electronic monitoring systems (EMSs), have been developed to promote increased hand hygiene (HH) adherence among healthcare workers (HCWs). The overall aim of this thesis was to explore the feasibility of an EMS for the HH adherence of HCWs. An EMS was installed on a surgical ward to assess the HH adherence of HCWs and provide them with digital feedback on their HH performances. In Study I, the accuracy of the EMS in relation to manual direct observations was evaluated. The results indicated an accuracy of 87.1% with a sensitivity of 90.2% and a positive predictive value of 95.7%. In Study II the impact of digital feedback to HCWs at both group and individual levels on adherence to HH was examined. Mean adherence to HH increased significantly from the baseline phase (37.9%) to the follow-up phase (52.5%, p<0.001). During the baseline phase, no feedback was provided, whereas the follow-up phase included 9 months, when both group and individual feedback were delivered. Studies III−IV were qualitative interview studies based on Grounded theory. In Studie III, the HCWs’ experiences of using the EMS were explored. A main strategy was defined as learning to interact with new technology, which was built on three conditions set by the HCWs, i.e. having trust in the monitoring system, requesting system functionality and ease of use, and becoming aware of one’s own performance. In Study IV, the experiences of the HCWs when implementing the EMS in clinical setting were explored. A core category was identified as collaborating for progress. This category was built on three interrelated categories that influenced each other: leading and facilitating, participating and contributing, and knowing and confirming. Taken together, the studies highlight the importance of a supportive and committed leadership, involving the HCWs in the implementation process. A well-functioning technology is a prerequisite for its adoption in daily work, and feedback contributes to increased adherence and awareness of HH. The findings of this thesis can encourage further development of technical innovations monitoring HH and its future implementation in healthcare.