Defeating Drug-Resistant Germs Named by CDC Requires Innovations in Hand Hygiene Monitoring

By Janel Nour-Omid

Drug-resistant germs represent a greater threat to Americans than previously understood, according to a new Centers for Disease Control and Prevention (CDC, 2019) report, sickening about 3 million Americans each year and killing about 35,000.

These bacteria, fungi and other germs pose a danger to individuals both inside and outside of hospitals. The report estimates that someone in the United States becomes infected by an antibiotic-resistant bug every 11 seconds, and every 15 minutes, someone dies.

The report underscores the urgency for the healthcare industry to address the problem through interventions such as good hand hygiene, vaccination, safe food handling and safe sex. The World Health Organization (WHO) stated in a 2009 report that “failure to perform appropriate hand hygiene is considered the leading cause of HAIs and spread of multidrug-resistant organisms.”

The new CDC report credits hospitals for improving their methods of tracking and slowing the spread of resistant germs, pointing out that superbug infections have decreased by nearly 30 percent since the CDC issued its 2013 report on antibiotic-resistant infections. But, as the 2019 report states, the problem is bigger than previously assumed.

Innovations in hand hygiene compliance monitoring can provide needed insights

While hand hygiene in hospitals has improved over the past decade, the CDC states that health care providers wash their hands less than half of the times they should, and other studies show that average compliance is even lower (McLaws et al., 2018; Eiamsitrakoon et al., 2013; Pan S-C, et al., 2013).

Compliance is lower than estimated because it drops off when providers are not being directly observed due to the Hawthorne effect – the alteration of behavior by the subjects of the study due to their awareness of being observed. Up until recently, direct observation was considered to be the “gold standard” of hand hygiene compliance measurement. But recent studies show that direct observation overestimates compliance by as much as 300 percent because compliance drops off significantly when healthcare workers are not directly observed, and most hand hygiene events are not directly observed (Hagel et al., 2015; Srigley et al., 2014).

To gain better hand hygiene compliance through more accurate monitoring, increased numbers of hospitals have moved toward electronic compliance monitoring, which was recently acknowledged by the Leapfrog Group as “an important component of a comprehensive hand hygiene program.” The group added electronic monitoring to its hand hygiene practice standards for 2019.

Hand hygiene data can be cross-referenced with incidence and locations of infections

As a provider of electronic hand hygiene compliance monitoring, Vitalacy has worked hand in hand with its clients to expand the patient safety capabilities of this technology. After implementing Vitalacy’s Patient Safety Platform, clients gather data including 1) the sheer number of hand washes, 2) the number of hand washes per hour, 3) the locations of all the hand washes, including the most and least used dispensers, 4) peak hand washing times, and much more.

These data provide insights and provoke questions about a hospital’s safety culture. After cross-referencing the hand washing data with infection data, the hospital can correlate the incidence of infections with hand hygiene compliance and make necessary improvements to patient safety.

The platform’s ability to map the locations and movements of care providers also enable it to observe workflow and make the daily rounding activities of staff more effective toward assuring patient safety. Hospitals have used the platform to better prevent falls with harm, pressure ulcers and deep vein thrombosis through purposeful rounding and to prevent nurse fatigue by measuring the miles walked and shift duration of staff.

Collaboration among all concerned parties is essential

To meet the current threat of drug-resistant germs, all concerned parties must collaborate to find solutions. Collecting accurate data about hand hygiene compliance and the location and incidence of healthcare-acquired infections is essential. Further research into the causes of antibiotic resistance is also warranted.

The more we understand about the biome of a hospital, the more effective will be our efforts to overcome the superbugs that afflict our patients.


Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2019.

Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013.

Eiamsitrakoon T, et al: Hand hygiene behavior: translating behavioral research into infection control practice. Infection Control and Hospital Epidemiology, November 2013;34(11): 1137-1145.

Hagel S, et al: Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observations with automated hand hygiene monitoring, Infection Control and Hospital Epidemiology, August 2015;38(8):957-62.

The Leapfrog Group. New in 2019: Section 6F Hand Hygiene Practices, May 29, 2019.

McLaws M-L, et al: Hand hygiene compliance rates: Fact or fiction?, American Journal of Infection Control (2018).

Pan S-C, et al: Compliance of healthcare workers with hand hygiene practices: independent advantages of overt and covert observers, Public Library of Science, Jan. 14, 2013.

Srigley JA, et al: Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system,: a retrospective cohort study, BMJ Quality & Safety, Dec. 2014;23(12):974-980.

World Health Organization 2009. Guidelines on hand hygiene in healthcare. WHO. Geneva.

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