How to Improve the Accuracy of Your Hand Hygiene Compliance Data

Updated: Sep 12

By Paul Gallese, PT, MBA

Compliance with hand hygiene protocols has been linked to reduced healthcare-acquired infections (HAIs). For example, an academic medical center reduced the incidence of HAIs for two consecutive quarters after the center increased its hand hygiene compliance from 30 percent to more than 70 percent (Vitalacy, 2019).

Being able to establish this link within your healthcare organization depends on having accurate compliance data. Gathering accurate data, however, is easier said than done. Some organizations, unfortunately, overestimate hand hygiene compliance and the impact their hand hygiene initiatives have on patient safety. There’s a difference between simply having a hand hygiene initiative and having an initiative that demonstrates by the collection of data that caregivers comply with hand hygiene protocols at a rate high enough to reduce the incidence of HAIs.

A common shortcoming of hand hygiene compliance measurement is reliance on a small sample of direct observations. Some organizations gather a relatively small data sampling through direct observation of hand hygiene compliance. Studies have shown that compliance rates determined in this fashion are sometimes overestimated because compliance drops when care providers are not observed, due to the Hawthorne effect – the alteration of behavior by the subjects of the study due to their awareness of being observed. Srigley et al., 2014 reported that this overestimation can be as high as 300 percent.

Automated compliance monitoring systems gather statistically valid data samples

Newer methods of measuring compliance use automated, or electronic, monitoring, which greatly increases the number of observations. The results of various studies of automated hand hygiene compliance monitoring have been promising. Michael et al. (2017) reports that an automated system with immediate feedback caused a rapid and sustained improvement in compliance. For example, one unit improved from 54 percent compliance over 12 months based on 88 direct observations to 98 percent compliance over 12 weeks based on 140,000 automated observations. Another study of an electronic system shows an increase of hand hygiene compliance of 25.5 percent, a decrease of healthcare-associated MRSA infections of 42 percent from baseline, and a savings of $434,000 over the study timeframe (Kelly et al., 2016).

By increasing the number of observations, healthcare organizations can achieve a truer measure of compliance. A high rate of compliance can quantitatively reduce HAIs – and accomplish a key objective of your patient safety program.

Automated systems can provide actionable feedback through customizable reports

Automated systems also can summarize large amounts of data quickly and provide actionable feedback through customizable reports made available on individual care provider, shift, unit and organizational levels. Another advantage is the limited personnel resources they require once implemented compared to direct observation strategies (Boyce, 2017).

These automated systems represent the latest technological advancement within the evolution of solutions designed to address patient safety challenges, such as falls, pressure ulcers, and deep vein thrombosis (DVT) through methods such as hand hygiene monitoring, purposeful rounding, nurse fatigue scoring, and mobile and web apps that provide real-time compliance reports. After creating awareness of the importance of hand hygiene and other preventive measures, healthcare organizations proceed along a continuum of actions they can embed into the safety culture and measure; most organizations start with simple compliance reminders and advance to direct observation programs, followed by more sophisticated automated systems.

What all electronic monitoring systems have in common is that they are “capable of capturing 100 percent of hand hygiene events, not a statistically insignificant sample, as is the case with direct observation,” Apler (2016) explains. “Observer bias and the Hawthorne effect are thus eliminated.”

Son et al., (2011) raises another key advantage of electronic systems, saying that they empower healthcare providers within a group or unit with “the responsibility to identify their own obstacles and barriers to proper hand hygiene, create action plans to remove them, and establish their own goals that can lead to sustainable improvement over time. . . They allow for tracking and reporting on an individual healthcare worker’s performance, so they can receive personal feedback . . . Most importantly, electronic monitoring systems tell the truth, better enable accountability, and can drive real performance improvement from an honest baseline. Accurate, reliable, timely, and actionable data is the key benefit.”

Learn more about Vitalacy’s automated monitoring systems at,



Alper P. To do no harm, rethink how to measure hand hygiene. Patient Safety & Quality Healthcare, May/June 2016;13(3):30-34.

Boyce JM. State of the Science Review: Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. American Journal of Infection Control, May 2017;45(5):528-535.

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

Michael H, et al: Durable improvement in hand hygiene compliance following implementation of an automated observation system with visual feedback. American Journal of Infection Control, 2017;45:311-313.

Son C, et al: Practically speaking: Rethinking hand hygiene improvement programs in healthcare settings. American Journal of Infection Control, 2011;39(9):716-724.

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.

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

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