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Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study

Published:January 02, 2023DOI:


      • Overall hand hygiene compliance before the intervention was low (44.1%) which was in line with other studies performed in intensive care units.
      • After our video camera hand hygiene surveillance, scenario based interactive education and feedback intervention, the overall hand hygiene and glove showed a non-significant improvement.
      • Only the before patient contact hand hygiene compliance rate increased significantly.
      • The improvements in hand hygiene behavior were not sustained in the long term (6 months after the intervention) follow period., illustrating the probable importance of continuous and frequent feedback and educations to sustain hand hygiene compliance.



      The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU).

      Methods and materials

      This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period.


      We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%).


      In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.

      Graphical abstract

      Key Words

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