Five Characteristics of Effective Hand Hygiene Monitoring Technology

By Tal Cohen, Vitalacy Chief Technology Officer

Technology in the healthcare workplace can evoke passionate responses from managers and staff, both positive and negative. Any individual response generally depends upon the experiences a person has had with technology in the past. Memories of glitches and downtime often bring skepticism. User-friendly, time-saving technology is welcomed and appreciated.

From where I stand as a technology professional, I have heard all the pros and cons. Our engineering team at Vitalacy has developed these five characteristics of effective hand hygiene and workflow monitoring technology. With the Leapfrog Group’s recent addition of electronic compliance monitoring to its hand hygiene practice standards, this technology is rapidly becoming more common in health care organizations. Our team has worked extremely hard to develop a reliable and durable system that helps care providers to do their jobs more effectively.

1. Effective technology doesn’t disrupt workflow; it makes workflow more effective.

Rule number one for our engineering team is to create technology that simply works, without requiring excessive training of staff. To the everyday care provider, Vitalacy’s technology only requires the wearing of a wristband or badge; this simple wearable helps to improve patient safety and workflow effectiveness.

2. Effective technology is preventive, not reactive.

Well-designed patient safety technology contributes to the prevention of healthcare-acquired infections and conditions (HAIs and HACs), as well as other adverse events. By sending reminders to care providers’ wristbands at the point of care, our technology can improve hand hygiene compliance. In the same fashion, our workflow monitoring platform reminds nurses to perform purposeful nurse rounding on patients at risk for common HACs such as falls, bedsores, and deep vein thrombosis (AHRQ, 2017).

3. Effective technology produces accurate and credible data.

Data will not be credible to your clinicians unless you can gather a high volume of reproducible data through a repeatable process. Direct observation of hand hygiene compliance provides a very low volume of data influenced by the Hawthorne effect, which describes how care providers achieve better-than-their-usual hand hygiene compliance when they are being observed, reducing the validity of the findings (Gould, et al., 2017). Studies estimate that only 1.2 to 3.5 percent of hand hygiene opportunities are captured via direct observation because of the tremendous number that occur, according to the Electronic Hand Hygiene Compliance Organization.

Vitalacy’s technology can gain hand hygiene compliance and workflow data 24/7 from all participating care providers. A recent Vitalacy implementation gained 225,000 automated observations over a three-month period, compared to 1,500 direct observations in the previous quarter (Vitalacy, 2019). In addition to providing a truly accurate compliance rate by hospital or unit, the data quantifies hand wash duration, nurse fatigue indicators, dispenser use, workflow patterns and much more.

4. Effective technology reinforces correct behaviors with immediate positive feedback.

It’s very important to make a user’s interface with technology positive and helpful. Monitoring technology can be perceived as being intrusive; some care providers fear the technology is being used to spy on them or to find proof of inadequate performance. When implementing our technology, our team emphasizes that the primary purpose of the technology is to improve patient safety and to assist care providers to do their jobs more effectively and safely.

With these goals in mind, our engineering team has integrated features into the technology that reinforce correct behaviors with positive feedback. For example, text messages or buzzes can provide positive reinforcement after hand washes. A mobile and web app gives care providers congratulatory messages for compliance improvements and high performance. Nurses have responded to these features by creating fun competitions between themselves and between other hospital units, turning their experience with the technology from cautious and skeptical into motivating and rewarding.

5. Effective technology enables improved quality and safety performance.

Changes made in response to performance data often correspond to quality and safety improvements. By cross-referencing hand hygiene compliance improvements with HAI and HAC incidence, healthcare organizations have demonstrated a correlation between better compliance and reduced adverse events (Kelly, et al., 2016; Pronovost et al., 2006). After improving hand hygiene compliance from 20 percent to 70 percent, an academic medical center working with Vitalacy reduced infection incidence on the monitored units for two consecutive quarters and expanded the project to all patient care units (Vitalacy, 2019).

Implementing new technology in a hospital is always a challenge. I hope that by considering the advice in this article, you can make your experiences with technology more fulfilling and less frustrating. Our team is always available to answer any questions you have about hand hygiene and workflow monitoring technology.

Tal Cohen is Vitalacy’s chief technology officer. Born in Israel and a military veteran, he gained his initial technology experience there before moving to the United States and starting to work for Vitalacy.


Agency for Healthcare Research and Quality (AHRQ). Final report: Estimating the additional hospital inpatient cost and mortality associated with selected hospital-acquired conditions. AHRQ publication No. 18-0011-EF, November 2017.

Gould D, et al: Impact of observing hand hygiene in practice and research: a methodological reconsideration. Journal of Hospital Infection, 2017;95(2):169-174. 10.1016/j.jhin.2016.08.008 file.

Kelly JW, et al: Electronic hand hygiene monitoring as a tool for reducing health care-associated methicillin-resistant Staphylococcus aureus infection. American Journal of Infection Control, 2016;44:956–957.

Pronovost P, et al: An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 2006;355:2725-32.

Vitalacy, Inc. Finding new ways to prevent healthcare-acquired infections and conditions. Mar. 14, 2019.

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