Electronic monitoring versus manual paper-based monitoring for hand hygiene compliance: A comprehensive health economic assessment analysis

Abstract

Abstract Background: Monitoring hand hygiene compliance (HHC) of healthcare providers (HCPs) in healthcare facilities is critical for hand hygiene (HH) promotion. However, less is known about the cost and effectiveness of different HHC monitoring tools. In this study, we aimed to compare various health economic indicators corresponding to electronic system-based monitoring (ESM) and manual paper-based monitoring (MPM) for HHC to provide evidence-based advice for HHC monitoring measures targeted selecting. Methods: A before and after self-controlled prospective study in 40 clinical departments with 4,524 HCPs was conducted from December 2022 to January 2023 (MPM implementation phase) and March 2023 to May 2023 (ESM implementation phase). The cost-effectiveness, cost-efficiency, the extent of the Hawthorne effect, and indirect cost-benefit of the two monitoring methods were compared. Results: Compared with ESM, every 1% increase in the HHC of MPM resulted in a 39,881.62 CNY reduction in cost. Acceptability of ESM was higher when the cost was 40,000 CNY or less. The cost-efficiency ratio of MPM in all departments (155,775.56 CNY) was higher than that of ESM (36,796.76 CNY). The Hawthorne effect of MPM of HHC in all departments (43.99%) was more pronounced than that of ESM (35.69%), with a statistically significant difference(p < 0.01). Conclusions: ESM exhibited notable advantages over MPM in terms of cost-effectiveness, cost-efficiency, cost-benefit, and the Hawthorne effect.