Sterillium disinfectant in a dispenser stands on a table. In front of it are 5 sensors from the NosoEX system
Hand hygiene 2.0

How digital solutions can help improve compliance

Illustration: Three hands touching each other.
E-mails, GPS navigation, QR codes: Everyday life without digital applications seems unimaginable today. In the healthcare sector digitalisation is increasingly important. An example of this is NosoEx® - a system that automatically tracks and evaluates hand hygiene in hospitals. In this interview, Thomas Kant, Digital Venture Architect from Global Marketing Disinfection at HARTMANN, reveals how the application works and the ways it helps facilities improve compliance.
A doctor disinfects her hands at a disinfectant dispenser.

Hand disinfection is an essential hygiene measure for hospital staff - especially before and after contact with patients. No surprise, given that 90% of all infections in the healthcare sector are transmitted via hands [1]. However, only one out of every two required hand disinfections is actually carried out [2].

Consequently, such inadequate hygiene compliance means pathogens can spread more easily in hospitals, sometimes causing serious illness among patients. In Europe alone, up to 3.8 million of these so-called healthcare-associated infections are registered every year [3]. At the same time, there are many ways to improve hand hygiene compliance in hospitals and thus prevent more infections. Thomas Kant explains one of them.

Mr. Kant, what challenges are healthcare facilities facing when it comes to hand hygiene?

Our healthcare system is currently suffering from an enormous shortage of skilled personnel. Studies show that in Germany alone, there will be a shortage of up to 1.8 million healthcare professionals in the hospital sector over the next few years [4]. This already often causes a huge overload for existing employees, leading to less and less time for essential medical and nursing tasks.

Hand hygiene, which is often neglected during a stressful working day, suffers as a result. If awareness of the need for hand disinfection is lacking as well, this inevitably leads to a drop in compliance.

What can digital tools do to change this for the better?

Digital solutions can bring about change in two ways: firstly, by making work easier, relieving the burden on staff and thus creating more time for regular hand disinfection. Secondly, they can provide better data and make processes more transparent. This in turn helps to identify potential areas for improvement and raise staff awareness.

And that's where NosoEx® comes in?

Exactly. NosoEx® is a solution that automatically tracks and evaluates hand hygiene. The aim is to create greater transparency regarding the status quo of hand hygiene in hospitals and make monitoring more efficient. As a result, NosoEx® also contributes to hand hygiene compliance optimisation. Based on the data collected, facilities can identify in which areas the hand hygiene compliance could be optimised to launch targeted interventions.

How does this work in practice? How is the data collected?

Sterillium® disinfectant dispenser equipped with NosoEx® Bluetooth sensor.
First, every hand sanitiser dispenser is equipped with a Bluetooth sensor that registers each disinfection process. This sensor can be attached to practically any type of dispenser - whether it is a wall dispenser, point of care dispenser, or mobile disinfection bottle. This allows us to record exactly when and where hand disinfection takes place, and how much disinfectant is used.

Does this also allow the hand disinfection behavior of individuals to be monitored?

No. The data gathered is completely anonymous. This means that we do not know which person disinfected their hands when, at which dispenser, and how thoroughly. Rather, the focus is to find out on which wards or ward zones comparatively more or less hand disinfection takes place and how different job groups vary in their behavior.

NosoEx® is therefore available in two versions: NosoEx® Basic and NosoEx® Advanced. The basic version generally records all hand disinfection at the equipped dispensers. The advanced version also allows the data to be broken down by occupational group. To do this, employees wear a color-coded Bluetooth transponder on their clothing. Each occupational group is assigned a different color and separate data can then be collected on nursing staff and doctors, for example. Except for the color, the transponders are completely identical and therefore do not allow any conclusions to be drawn about specific individuals.

Portrait: Thomas Kant
Thomas Kant
"NosoEx® can be an important building block in hospital hygiene, as it shows in black and white where improvements make sense."

How does the data collected help to improve compliance?

The recorded data is made available to the clinics via a special online dashboard. This allows those responsible to see directly how dispensers are being used on the various wards. After two to three months, it is very easy to see where there is a specific need for improvement in hand disinfection so that targeted measures can be taken.

NosoEx® also makes it possible to subsequently quantify corresponding measures such as training staff or purchasing additional dispensers. The dashboard allows those responsible to see, at a glance, whether or not hand disinfection behavior has improved following the measures. This also helps justify investments such as new dispensers, as it proves the positive effect of such measures in concrete figures.

NosoEx® helps hospitals to automatically track and evaluate hand hygiene to increase transparency and make the monitoring more efficient.

Does NosoEx® also have a direct influence on hand hygiene awareness for staff themselves?

Yes, there is definitely a positive effect here. Especially at the beginning, staff are particularly careful to disinfect their hands because they know that NosoEx® is collecting data about hand hygiene, so that the installation of the solution is directly an intervention.

In addition, clinics can always share the processed data to staff as ongoing feedback - for example via a separate monitor in the ward room where employees can check current figures. This means staff can always see for themselves how the ward has performed in terms of hand disinfection compliance compared to the previous week or month. If the figures are low, this can encourage improvement.

Portrait: Thomas Kant
Thomas Kant
"Transparency is key. Staff need to know what data is being collected and for what purpose it is being used."

How can you avoid staff feeling monitored and controlled?

The key is transparency. That's why we offer information events at facilities during installation of the system. There, we present NosoEx® in detail and explain to staff exactly what data is collected and evaluated. We also provide information material so that those responsible can always answer questions from staff.

Is there anything that the clinics themselves can do to promote acceptance of NosoEx®?

Transparency is needed, not only during the implementation phase, but also during ongoing operations. This includes regular evaluation of the data and sharing the results with staff. The aim is for employees to see exactly what data is collected and what measures result from it. Gamified approaches can also help here: For example, individual wards could compete against each other in small competitions, in which the team with the most hand disinfection wins. This creates trust and acceptance for the new system, as staff clearly recognise the benefits.

Speaking of benefits: Can the usefulness of NosoEx® also be proven in figures?

Group of nurses look at a clipboard and discuss.
NosoEx® has been part of various pilot projects over the past two years. In a clinic in Bamberg, for example, the basic version was tested on one ward and the advanced version on another. The result: NosoEx® not only increased hand disinfections by 11%, but the amount of hand sanitiser used also rose by 16%. After all, it is a common problem that staff use less disinfectant than required for proper hand disinfection. Where transponders were used, we also observed that hand disinfection increased by a full two thirds.

How do employees perceive working with the new system?

Those involved in the pilot projects completed questionnaires for this purpose. One of the most important findings was that the staff were now much more motivated to disinfect their hands and stated that they wanted to continue using the system in the future. It was also interesting to note that the employees were also interested in observing how hand disinfection behavior was developing on their ward.

What do facilities need to implement NosoEx®?

As the system is largely self-sufficient, it easily integrates into the existing infrastructure. Most common dispenser types can be equipped with NosoEx® so there is no need to buy new dispensers. For data transfer we use Bluetooth to be independent from the Wi-Fi network in the clinic. We install a router at one or two locations on the ward, which needs electricity, collects the data via Bluetooth, and then sends it to our server.

In addition to these technical requirements, the work culture must of course also be appropriate. A system like NosoEx® should not be imposed by force. Hygiene is a team sport and there must be openness and a strong feedback culture for this to work. It is a challenge for everyone: Manufacturers, sales, hospitals, and staff.


[1] Kramer A (2006) GMS Krankenhaushyg Interdiszip 1(1): Doc14

[2] KRINKO (2016) Bundesgesundheitsbl 59: 1189-1220.

[3] Suetens et al. (2018) Euro Surveill 23(46): pii=1800516

[4] pwc / Fachkräftemangel im deutschen Gesundheitswesen 2022

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