Skip to main content

A Feedback Information System for Improving Hand Hygiene on a Personal and Organizational Level

  • Conference paper
  • First Online:
Innovation Through Information Systems (WI 2021)


Hand hygiene plays a key role in the prevention of infections. However, there is still a lack of hand hygiene practices among both healthcare professionals and the public. Electronic hand hygiene monitoring systems have the potential to improve the situation by giving an accurate assessment of hand hygiene behavior and by placing digital interventions, but such systems are used only in a small number of healthcare facilities. Barriers that limit their large-scale adoption include high costs, privacy concerns, and usability. In this paper, we present a novel real-time feedback system that aims to overcome the existing barriers and supports hand hygiene on a personal and organizational level.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions


  1. 1.

    The literature screening was conducted with search engines of PubMed, ScienceDirect, and Google Scholar. Search terms included e.g.: “hand hygiene AND intervention AND hospital” or “hand hygiene monitoring system”.


  1. Bloomfield, S.F., Aiello, A.E., Cookson, B., O’Boyle, C., Larson, E.L.: The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. Am. J. Infect. Control 35, S27–S64 (2007).

    Article  Google Scholar 

  2. Stone, P.W., Larson, E., Kawar, L.N.: A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990–2000. Am. J. Infect. Control 30, 145–152 (2002).

    Article  Google Scholar 

  3. Erasmus, V., et al.: Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect. Control Hosp. Epidemiol. 31, 283–294 (2010).

    Article  Google Scholar 

  4. Tschudin-Sutter, S., Sepulcri, D., Dangel, M., Schuhmacher, H., Widmer, A.F.: Compliance with the world health organization hand hygiene technique: a prospective observational study. Infect. Control Hosp. Epidemiol. 36, 482–483 (2015).

    Article  Google Scholar 

  5. Boyce, J.M.: Hand hygiene compliance monitoring: current perspectives from the USA. J. Hosp. Infect. 70, 2–7 (2008).

    Article  Google Scholar 

  6. World Health Organization: WHO guidelines on hand hygiene in health care: first global patient safety challenge: clean care is safer care. World Health Organization, Patient Safety, Geneva, Switzerland (2009)

    Google Scholar 

  7. Boyce, J.M., Cooper, T., Dolan, M.J.: Evaluation of an electronic device for real-time measurement of alcohol-based hand rub use. Infect. Control Hosp. Epidemiol. 30, 1090–1095 (2009).

    Article  Google Scholar 

  8. Scheithauer, S., Bickenbach, J., Heisel, H., Fehling, P., Marx, G., Lemmen, S.: Do WiFi-based hand hygiene dispenser systems increase hand hygiene compliance? Am. J. Infect. Control 46, 1192–1194 (2018).

    Article  Google Scholar 

  9. Marra, A.R., et al.: The use of real-time feedback via wireless technology to improve hand hygiene compliance. Am. J. Infect. Control 42, 608–611 (2014).

  10. Radhakrishna, K., et al.: Real-Time feedback for improving compliance to hand sanitization among healthcare workers in an open layout ICU using radiofrequency identification. J. Med. Syst. 39(6), 1–8 (2015).

    Article  Google Scholar 

  11. Al Salman, J.M., Hani, S., de Marcellis-Warin, N., Fatima Isa, S.: Effectiveness of an electronic hand hygiene monitoring system on healthcare workers’ compliance to guidelines. J. Infect. Public Health 8, 117–126 (2015).

    Article  Google Scholar 

  12. Storey, S.J., et al.: Effect of a contact monitoring system with immediate visual feedback on hand hygiene compliance. J. Hosp. Infect. 88, 84–88 (2014).

    Article  Google Scholar 

  13. McCalla, S., Reilly, M., Thomas, R., McSpedon-Rai, D., McMahon, L.A., Palumbo, M.: An automated hand hygiene compliance system is associated with decreased rates of health care-associated infections. Am. J. Infect. Control 46, 1381–1386 (2018).

    Article  Google Scholar 

  14. Galluzzi, V., Herman, T., Polgreen, P.: Hand hygiene duration and technique recognition using wrist-worn sensors. In: Proceedings of the 14th International Conference on Information Processing in Sensor Networks - IPSN 2015, pp. 106–117. ACM Press, Seattle, Washington (2015).

  15. Mondol, M.A.S., Stankovic, J.A.: Harmony: a hand wash monitoring and reminder system using smart watches. In: Proceedings of the 12th EAI International Conference on Mobile and Ubiquitous Systems: Computing, Networking and Services. ACM, Coimbra, Portugal (2015).

  16. Llorca, D.F., Parra, I., Sotelo, M.Á., Lacey, G.: A vision-based system for automatic hand washing quality assessment. Mach. Vis. Appl. 22, 219–234 (2011).

    Article  Google Scholar 

  17. Filho, M.A.O., et al.: Comparison of human and electronic observation for the measurement of compliance with hand hygiene. Am. J. Infect. Control 42, 1188–1192 (2014).

  18. Doll, M.E., et al.: A comparison of the accuracy of two electronic hand hygiene monitoring systems. Infect. Control Hosp. Epidemiol. 40, 1194–1197 (2019).

    Article  Google Scholar 

  19. Gaube, S., Tsivrikos, D., Dollinger, D., Lermer, E.: How a smiley protects health: a pilot intervention to improve hand hygiene in hospitals by activating injunctive norms through emoticons. PLoS One 13, e0197465 (2018).

    Article  Google Scholar 

  20. Marques, R., Gregório, J., Pinheiro, F., Póvoa, P., da Silva, M.M., Lapão, L.V.: How can information systems provide support to nurses’ hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections. BMC Med. Inform. Decis. Mak. 17, 15 (2017).

    Article  Google Scholar 

  21. King, D., Vlaev, I., Everett-Thomas, R., Fitzpatrick, M., Darzi, A., Birnbach, D.J.: “Priming” hand hygiene compliance in clinical environments. Health Psychol. 35, 96–101 (2016).

    Article  Google Scholar 

  22. Diefenbacher, S., Fliss, P.M., Tatzel, J., Wenk, J., Keller, J.: A quasi-randomized controlled before–after study using performance feedback and goal setting as elements of hand hygiene promotion. J. Hosp. Infect. 101, 399–407 (2019).

    Article  Google Scholar 

  23. Conway, L.J.: Challenges in implementing electronic hand hygiene monitoring systems. Am. J. Infect. Control 44, e7–e12 (2016).

    Article  Google Scholar 

  24. Boyce, J.M.: Current issues in hand hygiene. Am. J. Infect. Control 47, A46–A52 (2019).

    Article  Google Scholar 

  25. Edmisten, C., et al.: Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals. Am. J. Infect. Control 45, 860–865 (2017).

    Article  Google Scholar 

  26. Armellino, D., et al.: Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare. Clin. Infect. Dis. 54, 1–7 (2012).

    Article  Google Scholar 

  27. Sahud, A.G., Bhanot, N., Radhakrishnan, A., Bajwa, R., Manyam, H., Post, J.C.: An electronic hand hygiene surveillance device: a pilot study exploring surrogate markers for hand hygiene compliance. Infect. Control Hosp. Epidemiol. 31, 634–639 (2010).

    Article  Google Scholar 

  28. Durant, D.J., Willis, L., Duvall, S.: Adoption of electronic hand hygiene monitoring systems in New York state hospitals and the associated impact on hospital-acquired C. Difficile infection rates. Am. J. Infect. Control 48, 733–739 (2020).

  29. Ellingson, K., et al.: Healthcare personnel perceptions of hand hygiene monitoring technology. Infect. Control Hosp. Epidemiol. 32, 1091–1096 (2011).

    Article  Google Scholar 

  30. Levin, P.D., et al.: Obstacles to the successful introduction of an electronic hand hygiene monitoring system, a cohort observational study. Antimicrob. Resist. Infect. Control 8, 43 (2019).

    Article  Google Scholar 

  31. Dyson, J., Madeo, M.: Investigating the use of an electronic hand hygiene monitoring and prompt device: influence and acceptability. J. Infect. Prev. 18, 278–287 (2017).

    Article  Google Scholar 

  32. Tiefenbeck, V., et al.: Overcoming salience bias: how real-time feedback fosters resource conservation. Manage. Sci. 64, 1458–1476 (2018).

    Article  Google Scholar 

  33. Centers for Disease Control and Prevention: When and How to Wash Your Hands. Accessed 14 Aug 2020

Download references


This work has been funded in part by the Bavarian State Ministry of Education, Science and the Arts within the framework “TechnologieAllianzOberfranken (TAO)”.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Carlo Stingl .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Stingl, C., Günther, S.A., Staake, T. (2021). A Feedback Information System for Improving Hand Hygiene on a Personal and Organizational Level. In: Ahlemann, F., Schütte, R., Stieglitz, S. (eds) Innovation Through Information Systems. WI 2021. Lecture Notes in Information Systems and Organisation, vol 46. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-86789-8

  • Online ISBN: 978-3-030-86790-4

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics