Monitoring compliance is crucial to improving hand hygiene, but what's the best way to do that? To help find the answer, the Emory University School of Medicine is researching the capabilities of electronic systems. The program is part of a three-year, $2.2 million Centers for Disease Control and Prevention grant.

"We hope to gain insight into how well these electronic systems work and whether it's sustainable," says James P. Steinberg, M.D., associate dean of clinical services and hospital epidemiologist at Emory University Hospital Midtown in Atlanta, and a primary investigator in the study.

Also serving as a primary investigator will be Bonnie Jennings, R.N. John Boyce, M.D., the former director of infection control and hospital epidemiology at Yale New Haven Hospital in Connecticut, will serve as a consultant.

The Emory study will take place over 18 months in about 200 patient care rooms at Emory University Hospital Midtown and Emory Johns Creek Hospital. Included are three wards and six intensive care units.

Boyce says monitoring by trained observers is considered the "gold standard" of measuring hand-hygiene compliance. "But direct observation also has numerous disadvantages, including the amount of time and personnel it takes to do the observations," he says.

Steinberg says part of the study will compare the compliance rate achieved through direct observation versus electronic observation. But he says the main thrust of the study is to look at which components of an electronic system have the potential to improve compliance.

The 500-plus participating health providers will wear badges with Bluetooth light beacons. Alcohol and soap dispensers inside and outside patient rooms will have sensors that detect if the hand-hygiene product is used and will relay that information to the Bluetooth beacon. The sensors will be connected by a wireless mesh network.

Some participants will be alerted with electronic voice reminders if they don't clean their hands at the appropriate times. Others will receive weekly feedback that shows how their compliance rates compare with those of their peers.

"We're trying to figure out what changes behavior," Steinberg says.

A secondary objective of the Emory research is to look at the technology's potential to reduce health care-associated infection rates, Steinberg says. But that aspect of the study will be limited because it cannot mandate that all employees participate, he says.

Sujan Reddy, M.D., medical director of the Prevention Epicenters Program of the Centers for Disease Control and Prevention, says the study still "will provide a lot of good evidence" of how electronic monitoring systems can affect health care-associated infection rates.