Hand hygiene is a key measure in preventing infections—especially critical within hospital settings. During the COVID-19 pandemic, Taoyuan General Hospital, Ministry of Health and Welfare (TYGH), experienced a major nosocomial outbreak that led to a 42-day shutdown. In response, the hospital collaborated with the Institute of Biomedical Engineering and Nanomedicine at the National Health Research Institutes (NHRI) to develop the world’s first non-camera, de-identified hand hygiene monitoring system. This innovative system was validated in the hospital’s intensive care units (ICUs) with an accuracy rate of 70% and was featured on the cover of the international journal Global Challenges in December last year.
According to Lun-De Liao, Deputy Director of NHRI’s Institute of Biomedical Engineering and Nanomedicine, numerous studies have shown that proper hand hygiene can effectively reduce cross-infection, shortening hospital stays and lowering mortality rates. There are five critical moments for hand hygiene in a hospital: before touching a patient, before clean or aseptic procedures (e.g., injections), after exposure to body fluids (e.g., changing a catheter), after touching a patient, and after touching the patient’s surroundings.
However, global data shows that the median hand hygiene compliance rate in healthcare institutions is only about 40%. Dr. Yi-Chun Lin from TYGH’s Department of Infectious Diseases noted that human nature includes inertia, and compliance often spikes only under observation—a phenomenon known as the Hawthorne effect. By incorporating Internet of Things (IoT) technology, hand hygiene can be better enforced, while also easing the supervisory burden on staff.
Cheng, Shu-Hsing, Deputy Superintendent of TYGH, explained that in January 2021, the hospital experienced Taiwan’s first hospital-acquired COVID-19 outbreak. It was traced back to a physician who, after performing intubation, failed to follow ideal hand hygiene practices, triggering a chain of infections that resulted in the 42-day closure. This event prompted TYGH to reach out to NHRI for support and collaborate in the development of this monitoring system.
Lun-De Liao elaborated that healthcare workers wear compact sensors, while dispensers for dry and wet hand cleaning, as well as sensors near bedsides, collect data via pressure, ultrasound, and Bluetooth signals. These signals are then converted into actionable data, uploaded, and analyzed. If wet handwashing lasts less than 40 seconds, a red text warning appears on a screen, with future updates to include vibration alerts via the wearable device.
In January last year, the system was piloted across eight adult ICUs at TYGH, achieving a 72% accuracy rate. Liao noted that because individual hand hygiene habits vary, the system also includes dry handwashing detection units installed on 11 mobile workstations outside the ICUs. It remains the only system globally that monitors hand hygiene without using cameras and in a fully de-identified manner—reducing the need for manual observation and data collection. Through continuous monitoring, the system aims to lower infection rates and improve patient recovery and survival outcomes.
Wei-Jen Chen, Deputy Director of NHRI, emphasized that ICU staff face heavy workloads and frequently enter and exit patient rooms. In such fast-paced environments, hand hygiene may be unintentionally neglected. This system offers a novel approach—one that neither interferes with workflow nor compromises privacy—while promoting better hygiene practices. Chen noted that this IoT-powered innovation could not only strengthen infection control but also improve staff retention and contribute to greater healthcare system resilience.
Resource: 預防院內感染！國衛院、部桃攜手開發無死角監測 「洗手監測系統」
