How do you know if your staff is practicing good hand hygiene? You observe — and hope that they don't spot you and your clipboard. But how efficient and effective is that?

"It's exceptionally time-consuming," says Andrew G. Sahud, MD, of the division of infectious diseases at Allegheny General Hospital in Pittsburgh, Pa. "It gives us only a small snapshot of data." Plus, it's very difficult for you to be inconspicuous while tracking the hand hygiene habits of others, creating the potential for a "Hawthorne effect," whereby subjects act differently when they know they're being studied.

To overcome these problems, Dr. Sahud worked with computer engineers to develop an electronic hand hygiene surveillance system that would automatically track compliance in real time, 24/7. Dr. Sahud says he's still modifying the system and studying (www.journals.uchicago.edu/doi/abs/10.1086/652527) whether it can improve hand hygiene "in a way that is not strictly punitive," for example, by letting workers monitor their own activity and alerting administrators only when compliance falls below a certain level.

While Dr. Sahud's solution is still in the development stage, a handful of technology and healthcare firms are already marketing automated hand hygiene monitoring tools that similarly capture compliance data in real time, alerting staff when they fail to wash their hands and making it easier for you to keep tabs on your facility's compliance rates.

— Irene Tsikitas

Amelior 360 Hand Hygiene from Patient Care Technology Systems
Through a combination of small radiofrequency ID tags worn by staff, ceiling-mounted sensors and interface modules attached to disinfectant dispensers, the Amelior 360 uses real-time locating system (RTLS) technology to monitor hand hygiene compliance with room-level or bed-level precision. Staff are notified when they have and have not complied with proper hand hygiene protocols before, during and after patient encounters. The system also sends compliance data to a centralized database that helps administrators track compliance rates, high-traffic areas and hand hygiene supply levels. www.pcts.com

BioVigil Hand Hygiene Monitoring System from BioVigil
This system has 3 components: an employee badge with an alcohol sensor and red and green LED lights, room sensors placed in any area that requires hand sanitation and a web-enabled base station that collects data from the badges. When a staffer enters a room, the room sensor activates the alcohol-sensing technology on the badge and turns the red light on. After the employee sanitizes her hands with an alcohol-based solution, she raises her hands to the badge to turn the light green. If she fails to do so, or if the badge doesn't sense enough solution on her hands, the red light will beep and blink until she performs hand hygiene. The badge sends compliance data back to the base station so you can track compliance. The LED lights also empower others to speak up when they see someone who needs to perform hand hygiene. $200 per badge, $200 per room, www.biovigil.org

CleanTracker RFID Compliance Monitoring from Resurgent Health & Medical
Resurgent's CleanTech automated hand washing systems feature rotating cylinders that provide a fully automated wash, sanitize and rinse cycle, eliminating up to 99.98% of pathogens from workers' hands. Resurgent offers the opportunity to upgrade these systems with its CleanTracker compliance monitoring technology, which picks up a signal from employees' RFID tags to identify when they performed hand hygiene and whether they completed a full handwash cycle. The information is automatically sent to a local- or web-based database, from which administrators can run compliance reports. www.resurgenthealth.com

HandGiene monitoring system from HandGiene Corp.
This RFID-based tracking system keeps a running, real-time tally of users' visits to HandGiene soap and hand sanitizer dispensers. The unique soap and alcohol-based hand sanitizers that come with the system both take 15 seconds of friction to dissipate. RFID-enabled tracking technology located in each soap dispenser and at the entrance to restrooms tracks compliance by picking up signals from a name tag or wristband issued to each staff member. The information is automatically sent to a web-based database that can be set up to flag incidents of non-compliance, letting administrators monitor specific employees, teams, stations, departments or shifts. $1,500 to $2,000 to outfit a 1-bed room with 2 standalone readers, 1 soap dispenser and 1 sanitizer dispenser, www.handgienecorp.com

iScrub Lite from the University of Iowa Computational Epidemiology Research
Still monitoring hand hygiene the old-fashioned way, with direct human observation? A new, free application for the iPhone or iPad Touch eliminates the need for unwieldy and conspicuous clipboards and pencils, letting you record your observations of hand hygiene compliance electronically and e-mail the data to yourself as an Excel-compatible spreadsheet. Developed by the University of Iowa Computational Epidemiology Research, the customizable app lets users add locations, job roles and observation notes. compepi.cs.uiowa.edu/iscrub

RFID Hand Hygiene Compliance Solution from Dynamic Computer Corp.
Infrared, RFID sensors located in soap dispensing units read staff ID badges to monitor the location and timing of hand hygiene compliance. After washing their hands, employees hear a verification sound that indicates the system has successfully captured that they performed hand hygiene and when and where they did so. The system can also be configured to alert staff members who forget to wash their hands (after entering a patient room, for example), which encourages a culture of safety by requiring staff to perform tasks in a certain order. $500 per room, www.dynamicrfidsolutions.com