Hand hygiene saves lives, the way hospitals track it hasn’t changed in decades. Many facilities still rely on short observational audits or rough consumption figures to estimate compliance. As clinical workflows become more complex and infection-prevention pressures rise, hospitals need a clearer, more detailed picture of what is happening at the point of care. Electronic Monitoring can help modern hospitals solve this problem.
Two recent studies published in the Journal of Hospital Infection show us what that future could look like. Both papers examine real-world hand hygiene behaviour in hospitals, and both show just how much information traditional methods fail to capture. Together, they make a strong case for electronic monitoring systems.
The first study, conducted in a German university hospital, took an unusually granular approach by measuring how much alcohol-based hand rub staff were using per disinfection event. Rather than simply counting how often dispensers were activated, the researchers monitored the actual volume dispensed, comparing this across professional groups and across different functional units. The variation they recorded was surprisingly wide. Nurses, physicians, and allied health staff all used different volumes. Certain units, such as urological endoscopy, consistently showed higher median volumes than others.
The pandemic added another layer of complexity. At the beginning of the pandemic, hand rub volumes spiked sharply as staff became more cautious. Over time this initial surge faded, but volumes never fully returned to pre-pandemic levels, suggesting a long-term behavioural shift. The study also tested the impact of feedback interventions designed to improve hand hygiene. Out of more than a hundred feedback measures delivered to staff, only a very small number produced any measurable improvement. This indicates that broad, non-specific messaging is unlikely to change ingrained habits; interventions must instead be targeted to the specific behaviours of distinct roles and units.
What this study makes clear is that measuring the number of activations alone is not enough. If a hospital only knows how many times a dispenser was used, it still knows very little about the quality of each activation. A staff member who sanitises frequently but consistently uses too little product may appear compliant on paper while still placing patients at risk. Electronic monitoring of volume per event gives infection-control teams a level of insight that simply cannot be reached through manual observation or consumption tracking.
The second study, conducted in intensive care units in Hungary, reinforces the importance of understanding context when evaluating hand hygiene behaviour. Over twelve months, researchers observed more than seven thousand hand hygiene opportunities and examined how compliance patterns correlated with infection rates. They found considerable differences in compliance from one ICU type to another, highlighting how local culture, workload, and layout can all influence behaviour. In at least one department, low compliance was directly associated with higher rates of healthcare-associated infections.
One of the findings concerned glove use. The study identified a strong link between unjustified glove use and poor hand hygiene compliance. In practice, this often means that staff, feeling protected by gloves, skip hand disinfection altogether—even when guidelines require it. This type of behaviour is almost impossible to detect through traditional monitoring. Yet it is exactly the type of pattern electronic monitoring, particularly when linked to badge or identity data, could track more comprehensively across entire units.
Taken together, these studies point toward a new era of infection prevention—one in which hospitals need to gather detailed, behaviour-level data rather than broad estimates. Direct observation tells only part of the story and is subject to bias. Total consumption figures can be misleading, as they do not capture whether staff are using the recommended volume per event. And because the behaviour of nurses, physicians, trainees, and specialists can significantly differ interventions must be informed by data that accurately reflects those differences.
This is where integrated systems such as OPHARDT’s smart dispensers combined with the Kanary platform can offer its value. Smart dispensers already track the frequency, timing, and volume of each disinfection event. This data can become even more granular when using one of our badge partners. By default, Kanary equips teams and Infection Control Practitioners to get detailed group-based feedback for each ward or unit. Badge systems help provide individual feedback. By supporting both team-based compliance by default and individual-monitoring through partners, Kanary can provide hospitals the solution that best suits them.
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