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Hospital workers did not improve their compliance with hand hygiene guidelines as a result of a quality improvement intervention using a novel electronic wearable device, a cluster randomized, stepped-wedge clinical trial showed.

Crude compliance with the World Health Organization's "5 Moments" hand cleaning scenarios actually dipped from 66.6% at baseline to 62.9% during the intervention period, though the difference did not reach statistical significance upon adjustment, according to Didier Pittet, MD, of University of Geneva Hospitals in Switzerland, and colleagues.

Nevertheless, the intervention did result in greater volumes of alcohol-based hand sanitizer used each time (median up from 1.2 mL to 1.71 mL) and longer durations of hand rubbing (from 6.5 to 8 seconds) during hand cleaning.

"However, the clinical significance of these results remains unknown, as our study was not designed to assess the impact of improving the quality of the hand hygiene action on the reduction of health care-associated infections," Pittet's group reported in . Partial results were presented at the .

The SmartRub device tested in the trial consists of a hand sanitizer bottle and a wristband. The system monitors how much sanitizer is being used and how long it is being rubbed into users' hands. For real-time feedback, the device vibrates after 15 seconds of hand rubbing.

The trial was conducted at a 300-bed geriatric hospital and enrolled 97 volunteer hospital workers. Participants were randomly split into four groups undergoing the intervention at different times.

For the study, auditors observed healthcare workers to measure their compliance with the for hand hygiene:

• Before touching a patient
• Before a clean procedure
• After body-fluid exposure risk
• After touching a patient
• After touching patient surroundings

Women accounted for 80 of the 97 volunteers, with a median age of 42. Participants were almost all nurses or assistant nurses.

Independent predictors of reduced hand hygiene compliance were days since study onset (odds ratio 0.997, 95% CI, 0.994-0.998), older age (OR 0.97, 95% CI, 0.95-0.99), and workload (OR 0.29, 95% CI, 0.20-0.41).

In total, there were 6,878 hand hygiene opportunities noted over 759 observation sessions in 2017-2018.

Some participants expressed concerns with the SmartRub device, namely confidentiality and potential interference with their clinical activities. "Importantly, the device might not be applicable in settings where a 'bare below elbows' strict policy applies," Pittet and colleagues said.

Moreover, the study encountered various technical challenges, such as random inactivation of the devices, loss of data because of errors in data transfer, they acknowledged.

Notably, the ongoing COVID-19 pandemic is thought to have improved hand hygiene in daily living among the general population.

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