Fostering hand disinfections in medical facilities: discussion of ethical conflicts and technical solutions.

BACKGROUND: Consistent compliance with hand hygiene is a crucial measure for the prevention of hospital-acquired infections. In recent years, various systems have been developed to support both nurses and doctors with improving their hand hygiene. However, the data sets collected to provide feedback offer the potential for excessive surveillance and punitive measures in cases of non-compliance, which creates an ethical conflict between promoting patient safety and preserving an ethically acceptable work environment for healthcare workers. METHOD: By adopting an interdisciplinary socio-technical approach and correlating the ethical concerns with the technological specification of such systems, the paper analyses this ethical conflict in detail. RESULTS: The paper demonstrates that optimized implementation strategies can minimize the ethical tensions. Additionally, the authors point out several aspects of the design process of such monitoring systems, including the active participation and involvement of staff, which positively contribute to the mitigation of this ethical conflict and also increase user acceptance of the systems. It also covers the deployment of a monitoring system in a hospital in Stralsund, Germany and discusses previous observations while simultaneously highlighting the problems with the design of the system according to the described ethical tensions. CONCLUSION: While the installation of a hand hygiene monitoring system can benefit the awareness for hospital hygiene, the development of such systems remains an ongoing and evolving process, particularly regarding the resolution of the ethical conflict. This paper argues that such systems should be used in a non-punitive and transparent manner, developed participatively with medical staff, and implemented in ways that ensure the collected data are used positively and responsibly.