Evaluating hand hygiene compliance: a digital-based approach for assessing healthcare worker practices in the Teaching Hospitals in Malaysia

Background: Hand hygiene compliance among healthcare workers (HCWs) remains a critical challenge in infection prevention. Traditional audit methods have limitations, including observation bias and Hawthorne effect. This study used eye-tracking technology to as an objective behavioural tool to assess and compare of HCWs compliance with infection control measures in two teaching hospital in Malaysia. Methods: A prospective observational study was conducted across two hospitals (Hospital I and II). Participants performed standardized patient care scenarios incorporating the “5 Moments for Hand Hygiene” technique while wearing eye-tracking glasses to monitor the compliance of HCWs. Handrub duration, scrub-the-hub duration and gaze behavior including dwell time, fixation time and saccade on selected areas of interest were recorded. Results: 75 HCWs (doctors and nurses) were recruited. Hospital I showed higher overall compliance (56.9%) than Hospital II (42.6%). Lowest adherence occurred at the moment "before patient contact". The average handrub duration of 13.63 s fell substantially below the WHO-recommended standard. Similarly, scrub-the-hub durations of 7.6 s in Hospital I and 4.13 s in Hospital II failed to meet the 10–15 s guideline, potentially compromising the effectiveness of these critical infection control measures. Medical station alcohol-based handrub (ABHR) dispensers received more visual attention than bedside ABHR, but did not consistently translate to compliance. Scrub-the-hub required the longest visual engagement, indicating procedural complexity. Conclusions: The use of eye-tracking technology in hand hygiene audits identified critical gaps in both compliance and technique quality. This study suggests the need for targeted training on proper durations, optimized ABHR placement, and technology-enhanced monitoring. This approach provides behavioral insights that could improve hand hygiene interventions and reduce infection risks.

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