ITS 81 - Utilization of an Electronic Hand Hygiene Monitoring System in Investigating an Increase in Clostridioides Infections

Background: Hand hygiene (HH) has been proven to be the most effective way to prevent the spread of infection. Monitoring of hand hygiene is typically performed through direct observation or electronic hand hygiene monitoring systems (EHHMS). In May 2021, an EHHMS system was installed in a 462-bed acute care hospital. The EHHMS allowed for increased HH observations, as well as electronic monitoring of soap and alcohol-based hand rub (ABHR) usage. Barriers identified during implementation of the EHHMS resulted in the installation of new HH dispensers to assist with compliance.

Methods: In May 2022, new HH dispensers were installed within the facility. Post-installation, it was noted that a change in soap usage coincided with an increase in Clostridioides difficile (C. difficile) infections. Utilizing the EHHMS, data was collected on soap dispenses and compared for correlation between C. difficile infections.

Results: During the pre-installation period (December 2021 – May 2022), C. difficile infections averaged three per month (n=17), ABHR usage was 71.1% (75,544/106,316), and soap usage was 28.9% (30,771/106,316). Post-implementation (June 2022 – November 2022), C. difficile infections increased to an average of six per month (n=33), ABHR usage increased to 90.5% (458,781/506,973), and soap usage decreased to 9.5% (48,192/506,973). While there was statistical significance in soap usage shown using a paired t-test (p=.003), there did not appear to be a correlation between soap and C. difficile infections using Pearson’s Correlation Coefficient (R=-0.421, p= >0.5).

Conclusions: ABHR is the primary means of HH in many healthcare facilities. Soap and water are recommended when caring for patients with C. difficile, as well as when hands are visibly soiled. Increased observations, as well as capability to monitor soap and ABRH dispenses through an EHHMS may be beneficial when considering factors in increased transmission of organisms such as C. difficile.