Making A Financial Case for Automated Hand Hygiene Compliance. Part 3: Cost of Penalties and Burnout

Updated: Sep 12

By Janel Nour-Omid, Vitalacy CEO and Cofounder

The first two parts of this series about how to make a financial case for automated, or electronic, hand hygiene compliance systems covered the costs of healthcare-acquired infections (Nour-Omid, July 26, 2021) and the costs of direct observation of care providers' compliance (Nour-Omid, Aug. 16, 2021). This article covers the cost of penalties received by hospitals with high infection rates, as well as the cost of burnout and other adverse effects on the health care labor force.

More than half of America's hospitals have been penalized at least once for having high infection rates

In early 2021, the Centers for Medicare and Medicaid Services (CMS) penalized 774 hospitals for having high rates of patient infections and/or other potentially avoidable medical complications. Because these hospitals ranked among the 25% of hospitals with the highest infection rates, they will now lose 1% of their Medicare payments over the course of 12 months (Sullivan, 2021).

More hospitals have been penalized through this Hospital-Acquired Condition Reduction Program, created by the Affordable Care Act, than you may have guessed. Since its inception seven years ago, 1,978 hospitals out of roughly 3,200 have been penalized at least once, 1,360 more than once, and 77 each year (Sullivan, 2021). Some of the penalized hospitals are well-known and considered among the best hospitals in America.

With the average hospital receiving about 22% of its revenues from the roughly $800 billion dollars of Medicare payments divvied up by American health care providers, a 1% hit to payments is significant.

Risk to personal safety now an additional concern for care providers

Having a stable and committed workforce is one factor that can help health care organizations to keep healthcare-acquired infections low. However, the COVID-19 pandemic has caused risks to personal safety to be an additional concern for care providers.

A recent report in The Lancet's open access journal EClinicalMedicine (Prasad, et al., 2021) described the results of a survey of 20,947 physicians and other workers. It found that 61% of those surveyed were afraid of exposing themselves or their families to COVID-19, 38% self-reported experiencing anxiety or depression, 43% suffered from work overload, and 49% had burnout.

Among the hospital workers reporting the highest levels of stress were nursing assistants, medical assistants, social workers and inpatient workers—such as nurses, respiratory therapists, nursing assistants and housekeepers. Women, Black and Latinx health care workers also reported higher than average levels of stress (Prasad, et al., 2021).

OSHA, Leapfrog, Joint Commission all place greater emphasis on hand hygiene during the age of COVID-19

As a result of findings such as this survey's, the Occupational Safety and Health Administration recently introduced an emergency temporary standard to protect health care workers from contracting coronavirus. Adopted from infection prevention and control protocols, the standard includes best practices for healthcare workers most likely to have contact with someone infected with the virus, as well as for those with lower exposure risk. Along with mask wearing, physical distancing and other precautions, the standard emphasizes the importance of hand hygiene.

The Leapfrog Group and the Joint Commission also recently issued stricter standards for hand hygiene. Leapfrog (2020) requires data on at least 200 hand hygiene compliance opportunities per unit per month, collected by automated hand hygiene compliance systems, direct observation, or a combination of both. If a Joint Commission surveyor sees only one clinician fail to clean their hands during direct patient care, the hospital will be cited with a deficiency, resulting in a Requirement for Improvement under the Infection Prevention and Control chapter of standards and requirements (Copeland, 2019).

Electronic hand hygiene compliance systems can reduce staff absenteeism, measure staff fatigue

A study by Strauch, et al., 2019 found that an electronic hand hygiene system in a hospital emergency department was associated with the health-related benefit of decreased absenteeism among community hospital emergency room nurses and technicians. The reduced absences resulted in less overtime hours worked by substitute staff and an unanticipated return on investment benefiting the health of employees.

In addition to potentially reducing illnesses among your staff and patients, Vitalacy's automated hand hygiene compliance system measures staff fatigue by keeping track of shift duration, shift frequency and miles walked – all signs of potential fatigue and burnout. These indicators often prompt conversations between nurses and their managers about physical and emotional stressors they may be experiencing (Gallese, 2020).

The Prasad study mentioned earlier in this article found that the odds of burnout were 40% lower among those who felt valued by their organizations; those who described themselves as valued comprised 46% of the survey's respondents. As the world continues to battle COVID, health care organizations must make a special effort to demonstrate to both their workers and patients their commitment to safety. Those that take their workers and patients for granted are likely to experience further penalties, burnout, and reputational damage.

Calculating the costs of NOT accurately monitoring and improving hand hygiene compliance must be part of the cost/benefit evaluation of these monitoring systems. We hope this three-part article will help you make that determination.

Contact Vitalacy today for a demo!


Copeland CS. The Joint Commission's new hand hygiene standards and what you need to know to stay compliant. Vitalacy Blog, May 7, 2019.

Gallese P. Monitoring for nurse fatigue can start important conversations about wellbeing. Vitalacy Blog, Feb. 18, 2020.

Leapfrog Hospital Survey. Factsheet: Hand hygiene, April 1, 2020.

Nour-Omid J. Making the financial case for automated hand hygiene compliance. Part 1: the cost of HAIs. Vitalacy Blog, July 26, 2021

Nour-Omid J. Making the financial case for automated hand hygiene compliance. Part 2: cost of direct observation. Vitalacy Blog, Aug. 16, 2021

Prasad K, et al. Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-10 pandemic: a national cross-sectional survey study. EClinicalMedicine, May 1, 2021, Vol. 35, 100879.

Strauch J, et al. Use of an automated hand hygiene compliance system by emergency room nurses and technicians is associated with decreased employee absenteeism. American Journal of Infection Control, May 2020;48(5):575-577.

Sullivan T. CMS penalizes 74 hospitals for high patient infection rates. Policy & Medicine, March 8, 2021.

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