{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:50:00Z","timestamp":1791809400937,"version":"4.3.4"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26105133_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Automated hand hygiene monitoring systems (AHHMSs) can monitor a large number of hand hygiene opportunities, and some provide real-time feedback; however, the impact of these systems is unclear. We sought to better understand how one of these systems improves hand hygiene adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105133_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The AHHMS was installed in seven units of an urban teaching hospital, and healthcare workers, primarily nurses and nurse technicians, were enrolled. We used a prospective observational cohort design with multiple interventions, including providing individual adherence rates and real-time voice reminders, to understand how these interventions improve hand hygiene adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105133_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Over the 40-week study period, 744,769 hand hygiene observations were observed among the 346 participants. The overall hand hygiene adherence rate increased from 37.0% (95% CI: 34.3% to 39.9%) at the start of the study to 55.5% (95% CI: 51.6% to 59.6%). This increase of 18.5% was statistically significant. However, adherence varied widely among different units and between individual participants. Voice reminders (58.7% (95% CI: 55.9% to 61.6%)) led to a significantly higher hand hygiene adherence rate than weekly individual feedback (46.4% (95%: 42.2% to 51.0%)) after adjusting for work shift and the seven individual participating clinical units. With the combination of interventions, improved adjusted adherence rates were sustained until the end of the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105133_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>After the introduction of the AHHMS, real-time voice reminders improved short-term hand hygiene adherence more than feedback of individual adherence rates. Multiple interventions and cultural changes are required to sustain improved adherence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10513","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:38:43Z","timestamp":1787719123000},"page":"1032-1038","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating feedback interventions to improve healthcare worker hand hygiene adherence using an automated hand hygiene monitoring system"],"prefix":"10.1017","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3062-6410","authenticated-orcid":false,"given":"James P.","family":"Steinberg","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1791-2677","authenticated-orcid":false,"given":"Ashley A.","family":"Tippett","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria L.","family":"Walsh","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puja Y.","family":"Shah","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4419-2617","authenticated-orcid":false,"given":"Kirk A.","family":"Easley","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health: Emory University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeta V.","family":"Shenvi","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health: Emory University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4626-1471","authenticated-orcid":false,"given":"John M.","family":"Boyce","sequence":"additional","affiliation":[{"name":"J. M. Boyce Consulting LLC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3848-6099","authenticated-orcid":false,"given":"Radhika","family":"Prakash-Asrani","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9811-6260","authenticated-orcid":false,"given":"Jesse T.","family":"Jacob","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"S0899823X26105133_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2023.02.003"},{"key":"S0899823X26105133_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2021.03.009"},{"key":"S0899823X26105133_ref15","first-page":"221","volume-title":"In Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability","volume":"1","author":"Huber","year":"1967"},{"key":"S0899823X26105133_ref27","doi-asserted-by":"publisher","DOI":"10.1086\/671738"},{"key":"S0899823X26105133_ref13","volume-title":"Analysis of Longitudinal Data","author":"Diggle","year":"1994"},{"key":"S0899823X26105133_ref12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa412"},{"key":"S0899823X26105133_ref2","doi-asserted-by":"publisher","DOI":"10.1086\/655441"},{"key":"S0899823X26105133_ref21","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jis542"},{"key":"S0899823X26105133_ref6","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2022.264"},{"key":"S0899823X26105133_ref3","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.93"},{"key":"S0899823X26105133_ref10","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2020.182"},{"key":"S0899823X26105133_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2024.03.012"},{"key":"S0899823X26105133_ref16","doi-asserted-by":"publisher","DOI":"10.2307\/1912934"},{"key":"S0899823X26105133_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2022.08.013"},{"key":"S0899823X26105133_ref26","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.173"},{"key":"S0899823X26105133_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2023.02.017"},{"key":"S0899823X26105133_ref18","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.141"},{"key":"S0899823X26105133_ref11","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2019.77"},{"key":"S0899823X26105133_ref20","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000000488"},{"key":"S0899823X26105133_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2021.05.011"},{"key":"S0899823X26105133_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2022.12.008"},{"key":"S0899823X26105133_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2025.04.005"},{"key":"S0899823X26105133_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2018.05.017"},{"key":"S0899823X26105133_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2020.11.007"},{"key":"S0899823X26105133_ref28","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofv121"},{"key":"S0899823X26105133_ref1","first-page":"1","article-title":"Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC\/SHEA\/APIC\/IDSA Hand Hygiene Task Force. 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}