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 and insignificant improvement.
      • 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. This shows the importance of continuous and frequent feedback and educations to sustain a high hand hygiene and glove use compliance.



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


      This is an interventional before-after trial conducted in a level-III NICU between July 2019-June 2020. The HH compliance was measured using the randomly selected video-camera footages 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 the HH compliance change. The compliance rates were tested as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study periods.


      We identified a total of 8335 HH indications. There was an increase in the total compliance rate of 9.0% (95% CI(-2%-20%)) at the time of intervention with increase in rate after intervention of 0.26% (95% CI(-0.31%-0.84%)) per day. The hand hygiene compliance before-patient contact significantly increase 19.8% (95% CI(4.8%-34.8%). Incorrect gloves use improved insignificantly with the intervention -3.4% (95% CI(-13.4%-6.7%)).


      In this study HH monitoring using video-camera footage combined with an intervention includes feedback, and education improved 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

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        • Kingston L
        • O'Connell NH
        • Dunne CP
        Hand hygiene-related clinical trials reported since 2010: a systematic review.
        Journal of Hospital Infection. 2016; 92: 309-320
      1. World Health Organization. The Burden of Health Care-Associated Infection Worldwide. A Summary; 2010. 2017.

        • Yapicioglu H
        • Satar M
        • Ozcan K
        • Narli N
        • Ozlu F
        • Sertdemir Y
        • et al.
        A 6-year prospective surveillance of healthcare-associated infections in a neonatal intensive care unit from southern part of Turkey.
        Journal of paediatrics and child health. 2010; 46: 337-342
        • Alp E
        • Orhan T
        • Kürkcü CA
        • Ersoy S
        • McLaws ML.
        The first six years of surveillance in pediatric and neonatal intensive care units in Turkey.
        Antimicrobial Resistance and Infection Control. 2015; 4: 34
        • Demirdağ TB
        • Koç E
        • Tezer H
        • Oğuz S
        • Satar M
        • Sağlam Ö
        • et al.
        The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point-prevalence study.
        Pediatrics & Neonatology. 2021; 62: 208-217
        • Ellingson K
        • Haas JP
        • Aiello AE
        • Kusek L
        • Maragakis LL
        • Olmsted RN
        • et al.
        Strategies to prevent healthcare-associated infections through hand hygiene.
        Infection Control and Hospital Epidemiology. 2014; 35: S155-S178
        • Pittet D
        • Allegranzi B
        • Sax H
        • Dharan S
        • Pessoa-Silva CL
        • Donaldson L
        • et al.
        Evidence-based model for hand transmission during patient care and the role of improved practices.
        The Lancet Infectious Diseases. 2006; 6: 641-652
        • Erasmus V
        • Daha TJ
        • Brug H
        • Hendrik Richardus J
        • Behrendt MD
        • Vos MC
        • et al.
        Systematic review of studies on compliance with hand hygiene guidelines in hospital care.
        Infection Control and Hospital Epidemiology. 2010; 31: 283
        • Clancy C
        • Delungahawatta T
        • Dunne CP.
        Hand hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review.
        Journal of Hospital Infection. 2021; 111: 6
        • McLaws ML
        • Kwok YLA.
        Hand hygiene compliance rates: fact or fiction?.
        American journal of infection control. 2018; 46: 876-880
        • World Health Organization
        • WHO Patient Safety
        Hand hygiene technical reference manual: to be used by health-care workers, trainers and observers of hand hygiene practices.
        World Health Organization, 2009 ([Internet]2009 [cited 2019 Oct 24]. Available from:)
        • Sili U
        • Ay P
        • Bilgin H
        • Hidiroglu S
        • Korten V.
        Hand hygiene knowledge, perception and practice of healthcare workers in a Turkish university hospital intensive care unit.
        The Journal of Infection in Developing Countries. 2019; 13: 744-747
        • Karaaslan A
        • Kepenekli Kadayifci E
        • Atıcı S
        • Sili U
        • Soysal A
        • Çulha G
        • et al.
        Compliance of healthcare workers with hand hygiene practices in neonatal and pediatric intensive care units: overt observation.
        Interdisciplinary perspectives on infectious diseases. 2014; (2014)
        • Chhapola V
        • Brar R.
        Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit.
        International Journal of Nursing Practice. 2015; 21: 486-492
        • Raskind CH
        • Worley S
        • Vinski J
        • Goldfarb J.
        Hand hygiene compliance rates after an educational intervention in a neonatal intensive care unit.
        Infection Control and Hospital Epidemiology. 2007; 28: 1096-1098
        • Brown J
        • Froese-Fretz A
        • Luckey D
        • Todd JK.
        High rate of hand contamination and low rate of hand washing before infant contact in a neonatal intensive care unit.
        The Pediatric Infectious Disease Journal. 1996; 15: 908-910
        • Shah R
        • Patel DV
        • Shah K
        • Phatak A
        • Nimbalkar S.
        Video surveillance audit of hand-washing practices in a neonatal intensive care unit.
        Indian Pediatrics. 2015; 52: 409-411
        • Shlomai NO
        • Rao S
        • Patole S.
        Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis.
        European Journal of Clinical Microbiology & Infectious Diseases. 2015; 34: 887-897
        • Sánchez-Carrillo LA
        • Rodríguez-López JM
        • Galarza-Delgado DÁ
        • Baena-Trejo L
        • Padilla-Orozco M
        • Mendoza-Flores L
        • et al.
        Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback.
        American Journal of Infection Control. 2016; 44: 868-872
        • Boyce JM
        • Cooper T
        • Yin J
        • Li FY
        • Arbogast JW.
        Challenges encountered and lessons learned during a trial of an electronic hand hygiene monitoring system.
        American Journal of Infection Control. 2019; 47: 1443-1448
        • Girou E
        • Chai SHT
        • Oppein F
        • Legrand P
        • Ducellier D
        • Cizeau F
        • et al.
        Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission?.
        Journal of Hospital Infection. 2004; 57: 162-169
        • Jain S
        • Clezy K
        • McLaws ML.
        Safe removal of gloves from contact precautions: The role of hand hygiene.
        American Journal of Infection Control. 2018; 46: 764-767
        • Brotfain E
        • Livshiz-Riven I
        • Gushansky A
        • Erblat A
        • Koyfman L
        • Ziv T
        • et al.
        Monitoring the hand hygiene compliance of health care workers in a general intensive care unit: use of continuous closed circle television versus overt observation.
        American Journal of Infection Control. 2017; 45: 849-854
        • Armellino D
        • Hussain E
        • Schilling ME
        • Senicola W
        • Eichorn A
        • Dlugacz Y
        • et al.
        Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare.
        Clinical Infectious Diseases. 2011; 54: 1-7
        • Hagel S
        • Reischke J
        • Kesselmeier M
        • Winning J
        • Gastmeier P
        • Brunkhorst FM
        • et al.
        Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring.
        Infection Control and Hospital Epidemiology. 2015; 36: 957-962
        • Stewardson A
        • Sax H
        • Longet-Di Pietro S
        • Pittet D.
        Impact of observation and analysis methodology when reporting hand hygiene data.
        Journal of Hospital Infection. 2011; 4: 358-359