Not all system are created equal

DebMed is the only electronic system clinically and scientifically proven to be an accurate and reliable method of measuring hand hygiene based on CDC guidelines, WHO 5-Moments, and the Public Health Ontario adaptation, 4-Moments for Hand Hygiene. 


The DebMed Electronic Hand Hygiene Compliance Monitoring System Clinical Compendium

Full text copies of the peer-reviewed studies can be requested using the form at the bottom of the page.

Peer - Reviewed Studies

1. Electronic hand hygiene monitoring as a tool for reducing healthcare-associated methicillin-resistant Staphylococcus aureus infection

Authors: Kelly J, Blackhurst D, McAtee W, Steed C.; AJIC, August 2016:

View AbstractA 746-bed teaching hospital used the DebMed Monitoring System over a 33-month period and achieved statistically significant outcomes: 1) 25.5% increase in the hand hygiene compliance rate; 2) 42% decrease in MRSA HAI infections; and 3) $434,000 in associated cost savings.

2. Hospital hand hygiene opportunities: Where and when (HOW2)? The HOW2 Benchmark Study. Am J Infect Control 

Authors: Steed C, Kelly J, Blackhurst D, Boeker S, Diller T, Alper P, Larson E.; AJIC, February 2011

View AbstractThe purpose of the study was to provide a benchmark from which to determine hand hygiene compliance rates by comparing product utilization to opportunities for hand hygiene based on the WHO 5 Moments guideline. 

3. Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: Validation of the HOW2 Benchmark Study

Authors: Diller T, Kelly J, Blackhurst D, Steed C, Boeker S, McElveen D.; AJIC, June 2014

View AbstractThis validation study used 24-hour video surveillance of healthcare worker hand hygiene activity. The results demonstrated that hand hygiene opportunities based on the WHO 5 method can be accurately calculated using a unit’s patient census and the patient-to-nurse ratio.

4. Introducing automated hand hygiene surveillance to an Australian hospital: Mirroring the HOW2 Benchmark Study. 

Authors: Azim S, Juergens C, Hines J.; AJIC July 2016

View AbstractValidation study tested the automated hand hygiene compliance data collection system (DebMed) against human auditors, and the found no significant difference to the averages reported in the 2011 study by Steed et al.


5. Hand Hygiene opportunities on Canadian acute-care inpatient units: A multicentre observation study 

Authors: Dhruv Nayyar MD, Christine Moore MLT, CIC, Liz McCreight BSc, CIC, Chiana Garvida BSc, Emily Xu BMSc, Alex Kiss PhD, Daniel R. Ricciuto MD, Allison McGeer MD, MSc and Jerome A. Leis MD, MSc

View AbstractMulticenter observational study. Medical and surgical inpatient rooms were randomized to receive 1 hour of continuous direct observation to determine hand hygiene opportunities (HHOs). HHOs were similar across inpatient units and hospitals. This estimate could serve to calibrate electronic hand hygiene monitoring systems for Canadian medical and surgical units.


Research presented at North American infection prevention and control association events

6. Innovative Use of Electronic Hand Hygiene Monitoring to Control a Clostridium difficile cluster on a Hematopoietic Stem Cell Transplant Unit

Authors: Natasha Robinson BSN RN , Sue Boeker BSN RN CIC , Connie Steed MSN RN CIC , William Kelly, MD

Study resulted in increased hand hygiene compliance to 93.9% and the CDI rate decreased to 2.38/10,000 patient days. Innovative uses of electronic hand hygiene monitoring and ongoing staff communication were contributing factors.

7. Canadian Four Moments versus the WHO Five Moments of hand hygiene – what is the actual difference? 

Authors: Alper P, McGreer A, Blackhurst D, Boeker S, Moore C.

Study found that recommending adherence to “The Canadian 4 Moments” was associated with 30.6% more hand hygiene opportunities than adherence to “The WHO My 5 Moments” program

8. Using an alternative to real time locating system for electronic hand hygiene monitoring at a VA hospital. 

Authors: Crnich C, Matteson K, Stampfli C, Hunt K, Landvoght T, McCarthy J, Phillips L, Rhinehart S, McKinley L.

Research found that sustainable improvements in hand hygiene performance are possible using technologies that provide real-time feedback of hand hygiene compliance based on the WHO 5-Moments.

9. Use of Targeted Solutions Tool (TST) and Electronic Monitoring to Improve Hand Hygiene Compliance

Authors: J William Kelly, Dawn Blackhurst, Connie Steed, Sue Boeker, Wendy McAtee

Study found that a modified version of the TST methodology, along with real-time data from electronic surveillance of HHC, resulted in consistent, sustained improvement in HHC rates across a spectrum of hospital units.

10. Use of an electronic hand hygiene compliance system to improve hand hygiene, reduce MRSA and improve financial performance. 

Authors: Bouk M, Mutterer M, Schore M, Alper P.

Using the DebMed Electronic Hand Hygiene Compliance System to measure and report performance led to sustained improvement in compliance, a 50% reduction in MRSA HAIs, followed by elimination of the readmissions penalty.


Articles and other supporting literature

11. Incorporating hand hygiene monitoring technology into a multi-modal infection prevention strategy drives infection rate reductions and hand hygiene compliance improvements

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By incorporating the DebMed System into its multi-modal infection prevention strategy, Atlantic Health System achieves a 69.5% increase in hand hygiene and infection rate reductions, including a 82% decrease in MRSA blood stream infections, 64% decrease in c. difficle infections, 58% decrease in surgical site infections, 47% decrease in CAUTIs

12. The DebMed System, a catalyst for hand hygiene culture change at Champlain Valley Physicians Hospital (CVPH) 

How CVPH achieved a 50% increase from the baseline hand hygiene compliance within 4 months of installing the system, exceeding their initial 40 percent goal eight months ahead of their targeted time frame.

13. Letter to the AJIC Editor: In response to “Automated and electronically assisted hand hygiene monitoring systems: A systematic review”

Author: Alper P.

Response to the May 2014 Ward et al. article to fill in some gaps in the research and learnings reviewed.

14. Letter to the AJIC Editor: In regarding “Comparison of hand hygiene monitoring using the My 5 Moments for Hand Hygiene method versus the Wash In-Wash Out method”

Authors: J William Kelly MD, Dawn Blackhurst DrPH, Connie Steed MSN, RN, CIC,

Response to the January 2015 study by Sunkesula et al. which compared hand hygiene based on a wash in-wash out method assessment to the My 5 Moments for Hand Hygiene method. Kelly et al. response questioned the generalizability of their findings on several grounds.

 15. To do no harm, rethink how to measure hand hygiene. Published in Patient Safety & Quality Healthcare, June 2016

Author: Alper P.

Article addresses the common practice of measuring compliance using observations, and why the flawed methodology should be replaced by electronic hand hygiene compliance monitoring systems.


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