Victor Martin

English 101
Dr. Thom Young
July 25, 2015
High Technology Used to Enforce Hand Hygiene:
A Better Way for Health Care Compliance
Can new technology be the solution for hand washing compliance in health care workers?
The reductions of infections among patients can be greatly improved if they quit being
irresponsible and start following hand hygiene policies. Hospitals need to enforce hand hygiene
compliance rather than relying on doctors and nurses to do it themselves. Hand hygiene is an
effective way to prevent the spread of hospital acquired infections, also known as nosocomial
infections. According to the World Health Organization (WHO), 40 percent of these infections in
patients are caused by deficient hand hygiene of health care providers (Emery, 2015). The report
also found that the average rate of them washing their hands was roughly 10 percent (Emery,
2015). For the most part, hand hygiene is not mandatory and hospitals only encourage their
workers. However, there are techniques today that actually enforce doctors and nurses to wash
their hands. Hospitals that use these techniques have reported more compliance as well as less
infection rates among patients.
The importance of hand washing for health care workers was first discovered by Ignaz
Semmelweis, the father of infection control. Through his work on infection control in the
maternity wards of Vienna, Austria in the 1840s, he noticed that there were high mortality rates
of babies. The mortality rates of babies delivered by medical students and doctors were much
higher than the ones that midwives delivered. He noticed that the medical students were coming

in contact with cadavers and then delivering babies afterwards. However, the midwives were
delivering babies without cadaver contact, so the mortality rates were low. So Semmelweis
created an experiment where physicians washed their hands after working on cadavers and then
delivering babies. As they started putting more emphasis on their hygiene along with the washing
of surgical instruments, the post-delivery mortality rate improved because of this. As a result,
Semmelweis realized that hand hygiene was very essential for any physician practice, and started
mandatory hand-washing policies at hospitals and medical institutions. The younger doctors and
medical students gave full support for his practices. However, the senior faculty stuck to the
miasmatic theory of infection, where they claimed that the hospitals new ventilation system has
spread bad air that was notably responsible for spreading bacteria that cause infections.
Semmelweis hand hygiene policies were not continued. Despite all that, two decades later, he
received remembrance for his endowment towards hand hygiene, but it only came after Louis
Pasteur discovered more evidence of bacteria and antiseptic proficinecy. These scientists were
pioneers in how important hand washing is today, in the prevention of spreading infections to
patients.
In many hospitals today, health care workers are not complying with hand washing, even
though they are aware of the evidence of how poor hand hygiene can spread infections to
patients. As stated previously, less than 10 percent of health care workers wash their hands
routinely (Emery, 2015). Among all health care workers, doctors have one of the lowest
compliance to hand washing (Young, 2013). This is really pathetic and careless behavior and has
led to approximately 722,000 patients developing hospital acquired infections (Centers for
Disease Control and Prevention, 2011). Of these, around 75,000 have died every year in the
United States due to poor hand hygiene in hospitals (CDC, 2011). Because of this, hospitals have

to spend more than 30 billion dollars in health care costs per year just to treat these patients
(Hartocollis, 2013). Many doctors report that they are too busy to wash their hands or complain
that they have excessive dry hands. Some of them just dont want to be told what to do. The
World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC)
have been acquiring data and developed guidelines that will help shape the future of the medical
profession. They have published posters and other visual images used around hospitals in order
to encourage doctors to comply with hand hygiene. These educational initiatives have been
encouraging, but they have not enforced doctors to comply. So far there has been little
improvement in hand washing compliance among health care workers. Researchers have studied
new techniques with the potential to enforce hand hygiene of doctors and nurses.
The original method for hand washing guidelines included educational aids, visual
images, and posters found throughout the hospital. These pictures usually instruct how to wash
hands and other ways to avoid spreading infections. This is very effective for health care workers
as it can help them comply and understand the mistakes they find in their own techniques.
However, it only encourages them to comply rather than enforce them. Even though this way can
be effective, doctors and nurses will not be going to these posters just to comply. This method
only influences them to wash their hands, but not to the extent of actually imposing them to do it,
since actions speak louder than words. The education found within these posters are very
informative, but no one is going to read them every day. As time passes, most health care
professionals will get used to seeing these placards to the extent of walking past them without
even noticing them. Posters and images do give them reminders for hand hygiene, but it does no
good in enforcing it. There are three techniques that could really enforce hand washing and can
perhaps revolutionize hand hygiene compliance among health care professionals.

Wristband technology has effectively made it possible for health care workers to comply
with hand hygiene. In hospitals with this type of method, the wristbands are scanned on to
hygiene stations, where an accelerometer uncovers how long a doctor spends washing. These
stations will be next to patient rooms to make sure that doctors are prepared for the procedure.
The wristband will also buzz or vibrate when its done correctly and three buzzes when its not.
The data from the bracelet is then handed to the hospitals epidemiologists, checking to see
whether they are doing fine or not. This new system will increase hand hygiene throughout the
hospital, because it will help their staff comply with hand washing by keeping track and giving
feedback.
Many health care professionals are opposed to wearing the wristbands because they are
an annoyance, disturbing them on a daily basis. However, their behavior needs to change for the
sake of the patient. It may seem a bit humiliating, but it is beneficial to avoid nosocomial
infections. In the beginning, it may seem terrible to get used to wearing the wristbands, but the
outcome will be very positive, because of the increase in hand washing, which have been shown
to lead to lower transmission of infections. Research shows that hand washing improved in
health care workers who wore the wristband from 25 percent to 44 percent when it was first
initiated (Korones, 2012).
Another form of technology to use is the sensor badges. Each physician and nurse wears
a badge that counts room entrances and exits, which will also be scanned in patient rooms. The
badge also performs different signals whenever a health care worker wears it. If they enter a
patients room without washing their hands, the badge will turn yellow and red after several
seconds of loud beeps. In order to stop it from beeping, they must wave a hand in front of the
badge that has been washed routinely. The vapor from the alcohol activates the sensor in the

badge that changes the light from red or yellow to green (Smith, 2014). This will help enforce
compliance among health care professionals, as they will need to wash their hands before going
into any type of room of a hospital. Doctors and nurses need to wash their hands or use hand
sanitizer if they dont want to hear a disarming sound
Just like the wristbands, doctors have called the sensor badges a humiliation and puts
them to shame, because of the noises and colors they make. This is only done to enforce them to
wash their hands. The badge makes noises just to alert the patients that a doctor or nurse did not
comply with hand hygiene. If they dont follow the rules, then they will be alerted to do so.
There are also complaints that it is expensive technology. However, the benefits outweigh the
costs because of prevention of infection among patients. This technology has proven to be
successful in many hospitals, with success rates ranging from 97 to even 99 percent for hand
hygiene compliance (Salter, 2013).
The third technology to enforce hand washing is the real-time video camera monitoring.
This works because of the Hawthorne effect, which is also known as observation bias. The
Hawthorne effect refers to people improving their behavior when they know they are being
watched. One example of this includes putting video cameras throughout hygiene stations. The
use of video cameras is a great way to enforce health care workers to wash their hands, because
they know they are being watched. The North Shore University Hospital in Manhasset, New
York has implemented the use of video camera monitoring. The images and data from the
cameras are transferred to third party auditors in India, where they measure the amount of hand
hygiene compliance that each health care worker had (Hartocollis, 2013). Armellino et al. (2011)
have reported that the compliance rate increased greatly from 6 percent to about 82 percent out
of 73,000 observations during 16 weeks. It was proven to be successful, as physicians wore

motion sensors that activate the cameras to track them when entering a patients room. Video
camera monitoring has also shown to sustain hand washing by enforcing doctors to show
awareness that they are being watched, and they must comply under any circumstance.
The problem about video monitoring is the fact that the hand washing compliance was
only measured when a doctor or nurse enters and exits a room. Despite the possible errors in the
report, video cameras monitor other aspects of patient care in the hospital as well, in addition to
hand hygiene. Being aware of a camera will feel completely normal to health care workers after
several months. Washing their hands should become a routine, while improving their
compliance. Since they see that camera every day, hand washing compliance will continue to
improve. Which is contrary to what critics think that their compliance will decrease as they get
used to the camera. Its also an expensive system for hospitals to install, but the benefits to the
patient outweigh the costs.
Even though these new technologies certainly help doctors to comply to hand hygiene,
there have been some criticisms. Many health care professionals arent excited about this
because they call it an annoyance or even humiliation, as they have to be reminded to wash their
hands properly. This is fairly ignorant, since they are basing their lack of hand hygiene on their
behavior towards it. Hand hygiene is very serious, especially in the medical profession. The
ability to say that wristbands and other technologies are going too far will go nowhere. Doctors
and nurses need to comply in order to prevent pathogens from spreading to patients. They
usually forget to wash their hands, which means that they are not taking it seriously. The posters
and images argue and try to be as persuasive as possible, but there is no way that they would be
reading something like this. With their busy schedules, health care workers are too busy to focus
on hand hygiene anymore, which is why technology is a better way to achieve compliance.

More hospitals should adopt these new technologies to enforce hand washing compliance
among health care professionals. Based on the current research, these techniques have shown a
major improvement when they are in use. Even though these technologies are very expensive, in
the long run, it has the potential to save many lives. This will also cut medical costs, because
now there are fewer patients to take care of with infections. Improving hand hygiene will
definitely make hospitals around the nation a safer and cleaner place. These three technologies
have been studied by researchers and show promising results for increasing hand washing
compliance. Every health care worker in the hospital has an obligation to prevent the spread of
infections to patients. Health care providers need to stop being self-centered, but focus their
attention on patient safety. There will also be a decrease in the death rate because of less
transmission of these pathogens from health care workers. Over time, the cost of these
technologies will probably drop because of increased demand from manufacturers as more
hospitals use them. Enforcing hand hygiene compliance is a better way to attack the problem
rather than encouraging health care workers to take it upon themselves. As we know, when left
up to the doctors and nurses, hand hygiene is often neglected. So lets take action now before its
too late.

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