Remote Video Auditing for Hand Hygiene

Lisa Moss Calderwood, MASenior Medical Writer

Calling on Big Brother in the Fight Against Hospital-Acquired Infections



Despite sobering statistics, many HAIs can be prevented with proper hand hygiene practiced by healthcare workers. How many times does a nurse or physician or cleaning person enter and leave a patient’s room each day (not to mention visitors and other non-hospital staff)? Multiply that times thousands of patient rooms in hospitals, nursing homes, and other clinical settings around the country, and it’s not so difficult to imagine why the statistics about HAIs are so daunting. In fact, although hand hygiene is widely accepted as an effective intervention to reduce HAIs, not many studies have explored the topic nor been designed to ensure compliance by healthcare workers.

However, a recent study on hand hygiene conducted by a Long Island hospital system yielded compelling results, albeit its methods had shades of Big Brother watching — orwashing as the title of a Clinical Infectious Diseases article stated: Big Brother is Washing…Video Surveillance for Hand Hygiene Adherence, Through the Lenses of Efficacy and Privacy.4 Yet the results of feedback from remote video auditing (RVA) are undeniable: being watched makes people comply with necessary protocols.

North Shore Long Island Jewish (LIJ) Hospital decided to conduct the study because it wanted to beat the odds on those dismal HAI statistics. Knowing that proper hand hygiene by healthcare workers was key to reducing HAIs, LIJ partnered with Arrowsight, a remote video auditing (RVA) company, to install cameras next to hand-washing and sanitizer-dispensing units outside 17 ICU rooms. The results were dramatic, most likely because hand-washing wasn’t just monitored by operators off site, data were also projected on LED screens on the hospital floor that all the workers could see.

In a video on the Arrowsight website, Adam Aronson, CEO, states about North Shore LIJ, “They thought their rate (of hand hygiene compliance) was at 60 percent and when we put the video cameras in and did many months of observation without giving any feedback, it turns out the rates were actually below 10 percent. …And so within about four weeks of beginning to give feedback, which was done through electronic digital boards right on the walls of the intensive care unit, and which could be seen by all the workers and their managers who could see what their real time hand washing rates were, rates went up and over 85 percent. It was a really big break through.”

While the authors of the published LIJ study conceded that the clinical conduct of the study wasn’t perfect (e.g., non-health care workers had to be eliminated from recordings the camera made and deleted from data on LED boards), there was no question that compliance significantly improved. In fact, the RVA was deemed so successful that North Shore LIJ recently installed cameras in two operating rooms of one of its Queens-based hospitals to monitor compliance with protocols for surgery prep, room cleanup, and timing — all designed to reduce surgical infections, wrong-site surgeries, and items left in patients during surgeries.

These kinds of errors don’t just affect patients’ health and safety; they also affect a hospital’s bottom line. With the Affordable Care Act, hospitals need to be cognizant about patient-centered care and reigning in costs. RVA is an interesting way to go about tackling one aspect of the problem.

Artcraft Health & Wellness offers innovative ways to tackle compliance issues. Our exceptional educational solutions for hospitals and clinics help reduce readmission rates, improve outcomes, increase staff compliance with safety protocols, and promote patient adherence with treatment plans. Contact Jennifer Schmidt, Account Executive to learn more about ways we can help you meet your institution’s goals.

Phone: 908-782-4921



1Health-care associated infections: the burden. Centers for Disease Control and Prevention. December 13, 2010.

2Klevens RM, et al. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Centers for Disease Control and Prevention.

3Scott II RD,The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, Centers for Disease Control, March 2009.

4Palmore TN, Henderson, D.K. Big Brother is Washing…Video Surveillance for Hand Hygiene Adherence, Through the Lenses of Efficacy and Privacy. Clin Infect Dis.2012;54(1):8-9. doi:10.1093/cid/cir781.

Also see: 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 Clinical Infectious Disease. Clinical Infectious Diseases. 2012;54(1):1–7.