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Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System

  • Matthew D. Koff (a1), Jeremiah R. Brown (a2), Emily J. Marshall (a2), A. James O’Malley (a2), Jens T. Jensen (a3), Stephen O. Heard (a4), Karen Longtine (a4), Melissa O’Neill (a4), Jaclyn Longtine (a4), Donna Houston (a3), Cindy Robison (a3), Eric Moulton (a3), Hetal M. Patel (a3) and Randy W. Loftus (a3)...



Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development.


To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events.


Randomized, prospective study.


Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts.


Patients undergoing surgery.


Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections.


A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); P<.001. Use of the hand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82–1.40], P=.626).


The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy.

Infect Control Hosp Epidemiol 2016;37:888–895


Corresponding author

Address correspondence to Randy W. Loftus, MD, University of Iowa Hospitals and Clinics, 100 Hawkins Rd, Iowa City, IA 52240 (


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(Present affiliation: Department of Anesthesiology, University of Iowa Hospitals and Clinics [R.W.L.].)



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