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Rapid phase I evaluation of a novel automated hand hygiene monitoring system in response to COVID-19
  1. Katie-Rose Cawthorne1,
  2. Darren Powell2,
  3. Richard PD Cooke1,2
  1. 1 Innovation Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  2. 2 Department of Laboratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Ms Katie-Rose Cawthorne, Innovation Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; katierosecawthorne{at}

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Summary box

What are the new findings?

  • A novel automated hand hygiene monitoring system, Hy-genie Lite (HL), was successfully implemented in a busy pathology department during the COVID-19 pandemic.

  • The system proved highly accurate with a sensitivity and positive predictive value of 99%.

  • Using HL, hand hygiene (HH) performance improved by 14.6% during a 6-week intervention period following group staff feedback. There was no significant change in pathology workload during the evaluation period.

How might it impact on healthcare in the future?

  • The full Hy-genie system is designed to give individual staff personalised feedback on their own HH performance with realistic improvement goals. This early study suggests that further evaluation of the complete system is warranted in a high-risk clinical environment.


Direct observation (DO) of hand hygiene (HH) behaviour remains the gold standard tool for measuring staff compliance during the COVID-19 pandemic. However, gathering HH data in the current environment may be challenging for many healthcare facilities due to resources being diverted to COVID-19 containment measures. Hence, audit on HH compliance may be severely compromised due to lack of labour force to perform DO. This is problematic as hospital transmission of COVID-19 is high.1

Automated hand hygiene monitoring systems (AHHMS) have been developed in recent years to enable healthcare organisations to gather robust HH data with minimal investment of labour. Group monitoring systems and badge-based systems are the two most common types of AHHMS available in the marketplace.2 Group monitoring systems track usage of HH dispensers to give an idea of HH frequency by staff groups. Badge-based systems typically require healthcare workers (HCWs) to wear an additional tracking device that communicates with dispenser-based sensors.

Hospitals with AHHMS already in place prior to the COVID-19 pandemic are in an advantageous position. An AHHMS was used to capture 35 million HH opportunities between January and May 2020 at the height of the pandemic.3 Capturing a …

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  • Contributors All authors contributed to the design, analysis and interpretation of the findings. The first author wrote the initial drafts. All authors approved the final submitted version.

  • Funding This project was funded by the Innovation Department at Alder Hey Children’s NHS Foundation Trust and Hand Hygiene Solutions Limited.

  • Competing interests K-RC and RPDC report personal fees from Hand Hygiene Solutions Limited. RPDC is also a director of Hand Hygiene Solutions Limited.

  • Provenance and peer review Not commissioned; externally peer reviewed.