Physicians’ compliance for hand hygiene in medical outpatient clinics: automated hand-hygiene monitoring with touch sensor and wireless internet


      • The hand hygiene compliance of physicians in outpatient clinics was investigated.
      • Automated counter using a push sensor attached to alcohol-based hand rub were used.
      • Hand hygiene was performed for 6.43% of patient visits, which is insufficient.
      • Interventions using posters and newsletters increased the compliance rates.
      • S. aureus detection rates on computer keyboards decreased after intervention.


      Outpatient clinics are reservoirs for significant pathogens. Hand hygiene with alcohol-based hand rubs are measures currently in use to prevent horizontal transmission of infections. The extent of compliance with hand hygiene regulations is unclear and difficult to monitor.


      We built an automated monitoring system with a pressure sensor attached to the alcohol-based hand rubs containers. Wireless fidelity (WIFI)-assisted data collection took place over 9 weeks. Interventions included posters, email reminders and newsletters. Hand hygiene compliance before and after these interventions was evaluated.


      Overall compliance with hand hygiene regulations was 6.48%; half of the physicians participating in our study performed hand hygiene at only 3.08% of patient visits. Twenty-four (17.9%) physicians performed hand hygiene with high compliance (≥10%), while 11.2% performed no hand hygiene at all. Physicians in academic positions and those with ≥20 years of experience performed hand hygiene less frequently than did other physicians. Compliance with hand hygiene regulations improved from 6.08% to 6.73% (P < .001) after intervention.


      Compliance with hand hygiene among physicians in our outpatient clinics was very low and needs to improve.


      Interventions improved the compliance somewhat, although additional interventions including education, training and feedback were suggested.

      Key Words


      ABHR (Alcohol-Based Hand Rub), WHO (World Health Organization), WiFi (Wireless Fidelity (Wireless Internet))
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