Healthcare workers' attitudes towards hand-hygiene monitoring technology

Published:March 01, 2019DOI:



      Automated radio-frequency identification (RFID)-based hand-hygiene monitoring technology was implemented in an infectious disease department to study healthcare workers' (HCWs') practices and to improve hand hygiene.


      To assess HCWs' attitudes towards this innovative monitoring device in order to anticipate resistance to change and facilitate future implementation.


      In-depth interviews and an ethnographic approach.


      From the perspective of HCWs, while they recognize the usefulness of RFID technology to prevent the transmission of infections to patients, they expressed concerns about risks related to RFID electromagnetic waves, as well as control by their superiors. Overall, HCWs' opinions oscillated between positive feelings characterized by enthusiasm for the possibility of changing their practices using technologies and research, and negative feelings marked by strong criticisms of these technologies and research. These criticisms included blaming hand-hygiene monitoring technology for decontextualizing HCWs' practices. They perceived the technologies through the prism of the local and national contexts in which they are embedded. From their point of view, technologies are primarily in the best interests of the project team. Thus, they affirm and maintain the different interests and objectives between themselves and the project team, crystallizing a conflict of professional norms and values between these two groups. The forms of resistance taken by HCWs were practical as well as oral.


      Innovative technologies should be developed to address HCWs' attitudes surrounding RFIDs. It is crucial to inform HCWs about the nature of these technologies, although some criticisms about monitoring systems are based on more structural causes.


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      1. WHO Guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. 2009
        • Pittet D.
        • Hugonnet S.
        • Harbarth S.
        • Mourouga P.
        • Sauvan V.
        • Touveneau S.
        • et al.
        Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.
        Lancet. 2000; 356: 1307-1312
        • Sax H.
        • Allegranzi B.
        • Chraiti M.N.
        • Boyce J.
        • Larson E.
        • Pittet D.
        The World Health Organization hand hygiene observation method.
        Am J Infect Control. 2009; 37: 827-834
        • Sax H.
        • Allegranzi B.
        • Uckay I.
        • Larson E.
        • Boyce J.
        • Pittet D.
        ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene.
        J Hosp Infect. 2007; 67: 9-21
        • Hagel S.
        • Reischke J.
        • Kesselmeier M.
        • Winning J.
        • Gastmeier P.
        • Brunkhorst F.M.
        • et al.
        Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring.
        Infect Control Hosp Epidemiol. 2015; 36: 957-962
        • Boudjema S.
        • Dufour J.C.
        • Aladro A.S.
        • Desquerres I.
        • Brouqui P.
        MediHandTrace®: a tool for measuring and understanding hand hygiene adherence.
        Clin Microbiol Infect. 2014; 20: 22-28
        • Dufour J.C.
        • Reynier P.
        • Boudjema S.
        • Soto Aladro A.
        • Giorigi R.
        • Brouqui P.
        Evaluation of handhygiene compliance and associated factors with a radio-frequency-identification-based-real-time continuous automated monitoring system.
        J Hosp Infect. 2017; 95: 344-351
        • Dufour J.C.
        • Reynier P.
        • Soto Aladro A.
        • Brouqui P.
        Input of innovative technology for surveillance and improvement of hand hygiene: the Medihandtrace® contribution to hand disinfection monitoring and intervention.
        Clin Microbiol. 2015; 4: 216
        • Staats B.R.
        • Dai H.
        • Hofmann D.
        • Milkman K.L.
        Motivating process compliance through individual electronic monitoring: an empirical examination of hand hygiene in healthcare.
        Manage Sci. 2017; 63: 1563-1585
        • Anderson J.
        • Gosbee L.L.
        • Bessesen M.
        • Williams L.
        Using human factors engineering to improve the effectiveness of infection prevention and control.
        Crit Care Med. 2010; 38: 269-281
        • Dawson C.H.
        • Mackrill J.B.
        • Cain R.
        Assessing user acceptance towards automated and conventional sink use for hand decontamination using the technology acceptance model.
        Ergonomics. 2017; 60: 1621-1633
        • Ajzen I.
        Attitudes, personality, and behaviour.
        Open University Press, Milton Keynes, UK1988
        • Eagly A.
        • Chaiken S.
        The psychology of attitudes.
        Harcourt Brace Jovanovich, Fort Worth, TX1993
        • Katz D.
        • Stotland E.
        A preliminary statement to a theory of attitude structure and change.
        in: Psychology: a study of a science. vol. 3. McGraw-Hill, New York, NY1959
        • Rosenberg J.M.
        • Hovland I.C.
        Fishbein M. Ajzen I. Belief, Attitude, intention and behavior. An introduction to theory and research. Addison-Wesley Publishing Company, Massachusetts, MA1975
        • Katz D.
        The Functional Approach to the Study of Attitudes.
        Public Opin Q. 1960; 24: 168-204
        • Barrau K.
        • Rovery C.
        • Drancourt M.
        • Brouqui P.
        Hand antisepsis: evaluation of a sprayer system for alcohol distribution.
        Infect Control Hosp Epidemiol. 2003; 24: 180-183
        • Denzin N.K.
        The research act: a theoretical introduction to sociological methods.
        Aldine Transaction, New York, NY2009
        • Guest G.
        • Bunce A.
        • Johnson L.
        How many interviews are enough? An experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82
        • Strauss A.
        • Schatzman L.
        • Bucher R.
        • Ehrlich D.
        • Shabsin M.
        The hospital and its negotiated order.
        in: Friedson E. The hospitzal in modern society. The Free Press, New-York1963: 147-168
        • Ward M.A.
        • Schweizer M.L.
        • Polgreen P.M.
        • Gupta K.
        • Reisinger H.S.
        • Perencevich E.N.
        Automated and electronically assisted hand hygiene monitoring systems: a systematic review.
        Am J Infect Control. 2014; 42: 472-478
        • Marra A.R.
        • Edmond M.B.
        New technologies to monitor healthcare worker hand hygiene.
        Clin Microbiol Infect. 2014; 20: 29-33
        • Srigley J.A.
        • Lightfoot D.
        • Fernie G.
        • Gardam M.
        • Muller M.P.
        Hand hygiene monitoring technology: protocol for a systematic review.
        Syst Rev. 2013; 12: 101-108
        • Larson E.
        Monitoring hand hygiene: meaningless, harmful, or helpful?.
        Am J Infect Control. 2013; 41: 42-45
        • Srigley J.A.
        • Gardam M.
        • Fernie G.
        • Lightfoot D.
        • Lebovic G.
        • Muller M.P.
        Hand hygiene monitoring technology: a systematic review of efficacy.
        J Hosp Infect. 2015; 89: 51-60
        • Boscart V.M.
        • McGilton K.S.
        • Levchenko A.
        • Hufton G.
        • Holliday P.
        • Fernie G.R.
        Acceptability of a wearable hand hygiene device with monitoring capabilities.
        J Hosp Infect. 2008; 70: 206-222
        • Ellingson K.
        • Polgreen P.M.
        • Schneider A.
        • Shinkunas L.
        • Kaldjian L.C.
        • Wright D.
        • et al.
        Healthcare personnel perceptions of hand hygiene monitoring technology.
        Infect Control Hosp Epidemiol. 2011; 32: 1091-1096
        • Marques R.
        • Gregório J.
        • Pinheiro F.
        • Póvoa P.
        • Mira da Silva M.
        • Velez Lapão L.
        How can information systems provide support to nurses’ hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections.
        BMC Med Inform Decis Mak. 2017; 17: 15
        • Fisher J.A.
        • Monahan T.
        Tracking the social dimensions of RFID systems in hospitals.
        Int J Med Inform. 2008; 77: 176-183
        • Meng M.
        • Sorber M.
        • Herzog A.
        • Igel C.
        • Kugler C.
        Technological innovations in infection control: A rapid review of the acceptance of behavior monitoring systems and their contribution to the improvement of hand hygiene.
        Am J Infect Control. 2018;
        • Belorgey N.L.
        Hôpital sous pression. Enquête sur le “nouveau management public”.
        La découverte, Paris2010
        • Dixon-Woods M.
        • Suokas A.
        • Pitchforth E.
        • Tarrant C.
        An ethnographic study of classifying and accounting for risk at the sharp end of medical wards.
        Soc Sci Med. 2009; 69: 362-369
        • Morgan D.J.
        • Pineles L.
        • Shardell M.
        • Young A.
        • Ellingson K.
        • Jernigan J.A.
        • et al.
        Automated hand hygiene count devices may better measure compliance than human observation.
        Am J Infect Control. 2012; 40: 955-959