Research Papers

SureWash is validated in numerous studies. View our published research papers below:

Gerard Lacey , Mary Showstark and James Van Rhee


Objectives: Hand hygiene is critical to patient safety, but low performance in terms of the quantity and quality of hand hygiene is often reported. Training-to-proficiency is common for other clinical skills, but no proficiency-based training program for hand hygiene has been reported in the literature. This study developed a proficiency-based training program to improve hand hygiene quality in line with World Health Organization (WHO) guidelines and assessed the amount of training required to reach proficiency. The training was delivered as part of a 5-day induction for students on the Physician Assistant online program.

Methods: A total of 42 students used a simulator to objectively measure hand hygiene technique over a 5-day period. Proficiency was achieved when students demonstrated all 6 steps of the WHO technique in less than 42 seconds. The students also completed a postintervention questionnaire.

Results: The average training episode lasted 2.5 minutes and consisted of 4.5 hand hygiene exercises. The average student completed 5 training episodes (1 per day) taking a total of 17 minutes. A total of 40% (17) of the students achieved proficiency within the 5 days. Proficiency was strongly correlated with the number of training exercises completed (r = 0.79, P < .001) and the total time spent training (r = 0.75, P < .001). Linear regression predicted that the 32 hand hygiene exercises or a total of 23-minute training were required to achieve proficiency.

Conclusions: This is the first study to develop a train-to-proficiency program for hand hygiene quality and estimate the amount of training required. Given the importance of hand hygiene quality to preventing health care–associated infections (HAIs), medical education programs should consider using proficiency-based training in hand hygiene technique.

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Gerard Lacey, PhD, MBA, Jiang Zhou, PhD, Xuchun Li, PhD, Christine Craven, SRN, MSc, Chris Gush, BS, MS (Essex)


Background: Poor quality handwashing contributes to the spread of nosocomial infections. We investigate the impact of automatic video auditing (AVA) with feedback on the quality and quantity of handwashing in a hospital setting.

Methods: AVA systems were mounted over all handwash sinks in a surgical unit. Phase 1 established baseline handwashing quality and quantity. Phase 2 examined the impact of real-time performance feedback, and phase 3 examined the incremental impact of weekly team performance reports. Phase 4 remeasured the baseline without feedback.

Results: A total of 3,606 handwash events were audited. During phase 2 and 3, compliance with the World Health Organization technique improved from 15.7%-46% (P < .0001), and the average number of handwash events per patient per day increased from 0.91-2.25 (P < .0001). Performance returned to baseline in phase 4.

Conclusions: AVA with real-time feedback significantly improved the quality and quantity of handwashing. The combination of AVA with electronic monitoring will allow simultaneous auditing of hand hygiene quantity and quality. The impact of cognitive offloading onto the technology may have contributed to the return to baseline at the end of the study, and suggests further research is required in this area.

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A. Higgins, M.M. Hannan


Background: In 2009, the World Health Organization recommended the use of a ‘multifaceted, multi-modal hand hygiene strategy’ (Five Moments for Hand Hygiene) to improve hand hygiene compliance among healthcare workers. As part of this initiative, a training programme was implemented using an automated gaming technology training and audit tool to educate staff on hand hygiene technique in an acute healthcare setting.

Aim: To determine whether using this automated training programme and audit tool as part of a multi-modal strategy would improve hand hygiene compliance and technique in an acute healthcare setting.

Methods: A time-series quasi-experimental design was chosen to measure compliance with the Five Moments for Hand Hygiene and handwashing technique. The study was performed from November 2009 to April 2012. An adenosine triphosphate monitoring system was used to measure handwashing technique, and SureWash (Glanta Ltd, Dublin, Ireland), an automated auditing and training unit, was used to provide assistance with staff training and education.

Findings: Hand hygiene technique and compliance improved significantly over the study period (P < 0.0001). Conclusion: Incorporation of new automated teaching technology into a hand hygiene programme can encourage staff participation in learning, and ultimately improve hand hygiene compliance and technique in the acute healthcare setting.

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Gerard LACEY, Michael Corra, Helga Morrowa, Ann McQUEEN, Fiona CAMERON and Chris CONNOLLY


Hand hygiene is recognized by the CDC as the most effective method of preventing Hospital Acquired Infections (HAIs) which cost the US healthcare system $14 Billion. However, training and promotion of hand hygiene in healthcare settings is an on-going challenge. This paper describes a hand hygiene improvement campaign in Edinburgh Royal Infirmary (Scotland, UK) using the SureWash gesture recognition system (SureWash, IRL). The campaign consisted of two phases of three-months each; the first phase involved technology evaluation and familiarization in a variety of settings within the hospital. The second phase involved rotation between two units with specific changes to the incentives for completing the training. There were 2,010 individual training sessions with over 30% outside of office hours. Individuals completed an average of 2.72 training sessions each and 90% of staff passed the assessment. Senior staff noted a change in hand hygiene culture following the campaign and the good-natured competition between staff to demonstrate hand hygiene competence using the SureWash serious game. While the new technology did facilitate the culture change its successful implementation was dependent on a set of incentives for staff and a structured implementation plan.

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Anarta Ghosh PhD, Stefan Ameling MSc, Jiang Zhou PhD, Gerard Lacey PhD, Eilish Creamer PhD, Anthony Dolan MSc, Orla Sherlock PhD, Hilary Humphreys MD


A novel artificial intelligence (AI) system (SureWash; GLANTA, Dublin, Ireland) was placed on a ward with 45 staff members for two 6-day periods to automatically assess hand hygiene technique and the potential effectiveness of the automated training system. Two human reviewers assessed videos from 50 hand hygiene events with an interrater reliability (IIR) of 88% (44/50). The IIR was 88% (44/ 50) for the human reviewers and 80% (40/50) for the software. This study also investigated the poses missed and the impact of feedback on participation (þ113%), duration (þ11%), and technique (þ2.23%). Our findings showed significant correlation between the human raters and the computer, demonstrating for the first time in a clinical setting the potential use of this type of AI technology in hand hygiene training.

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