On Hand Hygiene Compliance and Diminishing Marginal Returns: An Empirically-Driven Agent-Based Simulation Study

Failure of healthcare workers to perform hand hygiene is one of the leading preventable causes of healthcare-associated infections. Despite targeted interventions to improve hand-hygiene compliance, rates remain relatively low (averaging less than 50%) in many healthcare settings. Since it is much harder to raise compliance rates when rates are already high, achieving 100% compliance may ultimately be infeasible or cost prohibitive. In this paper, we use agent-level simulations empirically grounded in fine-grained healthcareworker movement data collected by wearable sensors deployed in a working intensive care unit to explore the effect of hand-hygiene compliance on the spread of healthcare-associated infections. These simulations permit us to determine if a “law of diminishing returns” applies to hand hygiene: in other words, is achieving 100% compliance always worth the cost?