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Electronic Monitoring Systems for Hand Hygiene Compliance

Last updated on July 9, 2021

Health Technology Assessment Committee Recommendations¹

  1. Electronic monitoring systems for monitoring hand hygiene (EMS) not be publicly provided in BC hospitals and residential care facilities until more evidence of its effectiveness and cost-effectiveness is available. 
  2. It is recommended that EMS be reviewed again when compelling new evidence becomes available, and that any trials in BC collect the necessary data for health technology assessment.

Health Technology Assessment Committee Findings

  1. Based on the best available evidence, group electronic monitoring systems for hand hygiene (EMS) may have some effect on improving hand hygiene compliance and reducing infections; however, at a relatively high cost compared to these potential benefits.
  2. Overall evidence of effectiveness of EMS (DebMed group monitoring system and Gojo Smartlink activity monitoring system) is limited to six observational studies of low to moderate quality. Studies report a positive effect on hand hygiene compliance; however, the effect size varied significantly across studies, ranging from 5% to 20% in absolute improvement, and multiple co-interventions in some studies meant the effect size could not be solely attributed to EMS.
  3. A cost-consequence analysis suggests that hand hygiene compliance rates could increase by about 5% with the introduction of EMS, at an incremental cost-effectiveness ratio (ICER) of $48,852 per case of Methicillin-resistant Staphylococcus aureus (MRSA) in acute care facilities and ICER of $160,258 per MRSA case in residential care facilities.
  4. The annual incremental cost to implement the DebMed EMS in all acute care facilities across BC is estimated to be $3.4M for the first two years (phase-in), $2.8M annually after that, and $29.2M over ten years. In residential care facilities, the annual incremental cost for BC is estimated at $3.9M for the first two years, $3.8M annually, and $38.5M over ten years.
  5. Overall, based on the available evidence, the costs that may be avoided due to reduced infections and reduced resources dedicated to direct observation are not likely to outweigh the implementation costs of the technology.
  6. In sensitivity analysis, it was determined that EMS could be potentially cost saving if the technology was significantly less expensive and MRSA treatment costs are greater than current estimates in the published literature. If these conditions are met, due to uncertainty, there is a moderate chance (50%-60%) of EMS being cost-effective in acute care settings within a range of willingness-to-pay thresholds, but not in residential care.
  7. MRSA is one of the most commonly reported healthcare associated infections (HCAI) in BC. At the same time, it is important to note that this analysis only looked at MRSA cases due to data limitations, and this limitation likely underestimates the burden and cost of HCAIs for the BC health care system.
  8. EMS is reported to be easy to implement and relatively invisible to the health care provider and the patient. Important considerations for implementing a group EMS include ensuring confidence in the technology’s measurements, addressing data ownership in contractual agreements between manufacturers and health care providers, and once implemented ensuring results are communicated to health care providers to support quality improvement where needed.
  9. The Gojo Smartlink EMS would be more applicable to the BC context if its monitoring system could be validated using the Canadian Your 4 Moments for Hand Hygiene and adapted to hospital rooms with multiple beds.

The Health Technology Assessment Committee’s recommendations on Electronic Monitoring Systems for Hand Hygiene Compliance were accepted by a committee of senior health authority and ministry executives in June 2018. Please note: health authorities determine how health technologies are implemented within their programs and services. Other relevant scientific findings may have been reported since the completion of the reference documents used to form the basis of the Committee's recommendations.