The Sani Nudge Clinical Advisory reflects on the World Health Organization’s (WHO) recommendation on automated systems for hand hygiene improvement.

In a newly published article from Pittet, Allegranzi, Sax, and Kilpatrick in BMJ Quality & Safety, the authors and innovators of infection prevention research share that “WHO is particularly attentive to encourage innovations, such as non-touch dispensers, automatic monitoring systems and other technologies taking human factors and ergonomics into account, and more sophisticated adult learning educational approaches to facilitate uptake, such as gaming and augmented reality applications.”  

We asked some members of the Sani Nudge Clinical Advisory Committee to share their insights on this critical topic based on their own experiences in healthcare and the value that innovations bring to their peers and healthcare workers as a whole. 

Hans Jørn Kolmos on ensuring better hygiene in healthcare

Hans is a professor of clinical microbiology (University of Southern Denmark), Professor Chair of clinical microbiology (Odense University Hospital), Board member at International Federation of Infection Control, and Knight of the Order of Dannebrog 

Podcast featuring Hans: Podcast featuring Hans: Irrespective of excuses, primum non-nocere

He is a published author of Hygiene for Clinicians (available in Danish at Hygiejne for klinikere). He shares these crucial insights regarding the announcement: 

“Everyone recognizes the importance of hand hygiene, but we also know how difficult it is to achieve consistently high compliance in daily practice. Knowledge of hand hygiene and physical access to hand hygiene facilities is not enough.

In recent years, technological solutions have been developed based on “nudging”, which helps the staff comply with the hand hygiene requirements and provide feedback on how good one is at complying with these. Such simple and easy-to-understand electronic systems have given hand hygiene a critical boost and helped ensure high compliance, even in busy everyday life.

It is very gratifying that the WHO is now also recommending automated and digital hand hygiene solutions to ensure better hygiene in our hospitals and long-term care facilities.”

Else Smith on Hand hygiene in the 21st century

Else is the former CEO of the Danish Health and Medicine Authority, Board member of the WHO, the ECDC, and the EMA, Director at the Danish National Disease Surveillance Institute, and CMO of two hospitals. 

Podcast featuring Else: Revolutionary transformations in healthcare take time

“Good and effective hand hygiene is central when we want to reduce healthcare-associated infections and resistant pathogens in the healthcare system. 

For many decades, there has been a focus on hand hygiene and finding effective methods to measure hand hygiene events. The World Health Organization has also had this focus for years. Many places have tried interventions with flyers, stickers, posters, training, but with limited results. Typically, hand hygiene was monitored using direct manual observations. Such methods are resource-intensive. 

Now the WHO is changing strategy and calling for innovative automated solutions, including that all countries and hospitals focus on hand hygiene as a KPI.

Also, in Denmark, hospitals, in particular, have struggled with hand hygiene and hospital-acquired infections, including the spread of resistant bacteria. We should take the lead here and ensure that automated registrations are implemented everywhere. In addition, ensure that all staff understand the importance of hand hygiene, and this should be good timing in light of the corona pandemic.”


Rosie Bartel on the patient experience

Rosie is a contributing patient ambassador. 

Podcast featuring Rosie on her experience as a Healthcare-Associated Infection Survivor

“My thoughts on this critical topic are that as a patient, hand hygiene is a simple way to prevent infections, yet it is often one area that healthcare professionals fall short on all levels. As a patient advisor, I believe there is a need for better auditing and monitoring of hand hygiene.

During Covid-19, most patients thought hand hygiene would improve, but that did not happen. I was hospitalized three times during Covid-19, and the hand hygiene practices were some of the worst I have experienced as a patient. Covid-19 areas might have had good hand hygiene, but the other patients without Covid-19 were experiencing a lack of hand hygiene because healthcare providers were not being monitored as closely as they were before Covid-19.

I believe WHO’s new statements will provide opportunities for retraining healthcare professionals and finding new and innovative ways to monitor and audit hand hygiene. As a patient advisor, I consider hand hygiene a key indicator of the healthcare system’s quality of care and view it as a minimum requirement to save lives.

There is an excellent new technology for monitoring hand hygiene, but the monitoring information is only valid when driving quality improvement. If the data collected from hand hygiene monitoring isn’t used to improve patient outcomes, then the data is just another form of evidence that does not drive change. Using this real-time data to drive training around hand hygiene is the only way to create improved actions that will lead to better patient outcomes. This is a simple way to improve outcomes, yet hand hygiene monitoring is not being used to retrain and guide healthcare professionals in real-time in many healthcare systems.

I have seen a paradigm shift in hand hygiene monitoring and technology, but I do not see the data used to retrain healthcare providers around hand hygiene compliance. 

The monitoring is often tracked for staff evaluation, but patient outcomes aren’t tracked concerning hand hygiene. Infectious disease research needs to follow up on hand hygiene monitoring and how infections increase or decrease with hand hygiene data.

I will continue to share my story worldwide to achieve this goal.”

These statements can drive conversations with healthcare organizations (hospitals and long-term care facilities) for improvement and support in much-needed infection prevention conversations.

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