COVID-19 Compliance Monitoring in Hospitals: Insights from Automated Hand Hygiene Tracking
Hand hygiene has long been a foundational practice in infection prevention, yet actual compliance in hospitals often lags behind expectations. National averages hover around 50%, despite ongoing education and awareness campaigns. Traditional audit methods rely heavily on direct observation, capturing a limited sample and often yielding unreliable data. To improve COVID-19 compliance monitoring in hospitals, some institutions turned to automated monitoring systems during the pandemic. This article examines how one major medical center used automation to track and enhance hand hygiene compliance at the peak of the COVID-19 crisis.
Monitoring System and Study Design
In 2015, the University of Chicago Medical Center (UCMC) implemented the PURELL SMARTLINK Integrated Monitoring System (GOJO Industries), one of the most extensive automated hand hygiene systems nationwide. The system uses infrared sensors to anonymously track two core metrics:
- Numerator: Hand sanitizer dispenser activations
- Denominator: Staff entries into and exits from inpatient rooms
These data points allow the calculation of a real-time hand hygiene compliance rate. Results are visualized on unit-based displays and distributed via weekly reports, supporting transparent, data-driven compliance monitoring in hospitals.
The analysis focused on UCMC’s new adult hospital from September 2019 to August 2020. Researchers evaluated trends across inpatient units and intensive care units (ICUs), including several that were temporarily converted into COVID-19 cohort units. These cohort units exclusively cared for COVID-positive patients and offered insight into potential peak compliance levels under heightened infection control awareness.
To contextualize the data, researchers also tracked the number of hand hygiene “opportunities” (room entries/exits) and COVID-19 admissions over time. Statistical analysis was conducted using bivariate linear mixed models to assess month-to-month differences.
Results: Surging Compliance During COVID-19
During the study period, UCMC admitted 1,159 COVID-positive inpatients, with the highest admissions in April 2020.
Key findings include:
- Pre-pandemic baseline: Hand hygiene compliance was around 54.5% in September 2019.
- Daily peak: Compliance reached 92.8% across all units and 100% in COVID cohort units on March 29 and March 28, 2020, respectively.
- Weekly peak: The highest weekly averages were 88.4% (all units) and 98.4% (cohort units) during the week of March 29, 2020.
- Monthly peak: April 2020 saw monthly highs of 75.5% (all units) and 84.4% (cohort units).
- Decline over time: By August 2020, compliance dropped to a daily low of 51.5%, with corresponding weekly and monthly declines.
Statistical analysis confirmed a significant relationship between month and compliance levels. Interestingly, the number of room entries and exits (i.e., hand hygiene opportunities) had an inverse correlation with compliance—suggesting that as opportunities increased, adherence declined.
Discussion: What the Data Tells Us About COVID-19 Compliance Monitoring in Hospitals
This study highlights the capability of hospitals to achieve exceptionally high levels of hand hygiene compliance—well above the institutional goal of 60% and the national average—especially during times of heightened awareness like the early months of the COVID-19 pandemic.
However, these elevated compliance rates were not sustained. After the initial surge in awareness and urgency, behaviors returned to baseline, even with automated monitoring in place. Several factors contributed to the initial surge:
- Increased risk perception: Staff were acutely aware of infection risk.
- Reduced traffic: Visitor restrictions and remote clinical rounds reduced the number of entries/exits per room.
- Task batching: Nurses began combining activities to minimize room entries.
These behavior shifts temporarily improved compliance but proved difficult to maintain as hospital routines normalized.
Implications for Future Compliance Monitoring
This case study illustrates both the potential and the limitations of automated compliance tracking in hospital settings. Key takeaways for hospitals seeking to improve COVID-19 compliance monitoring include:
- Automation increases data accuracy and visibility, providing a more reliable compliance baseline than manual observation.
- Pandemic-related behaviors—such as visitor restrictions and remote workflows—can temporarily improve compliance rates.
- Sustaining high compliance requires more than technology; it demands cultural and systemic reinforcement of best practices.