Electronic Monitoring Systems

How SMARTLINK™ Technology Empowers Hospitals in the Fight to Prevent HAIs and Protect Reimbursements

Lori Moore


By Lori Moore, RN

Clinical Application Specialist, GOJO Industries

The frequency of healthcare-associated infections (HAIs) is an increasingly important metric in hospital evaluations that affects millions of dollars in reimbursements from the Centers for Medicare and Medicaid Services (CMS).

Multiple studies have demonstrated the effectiveness of proper hand hygiene in helping to prevent the spread of infections. However, achieving sustained compliance with recommended practices is a major challenge in hospitals.

What’s needed is a reliable set of tools for monitoring and reporting hand hygiene activity, and a structured program for developing targeted interventions with ongoing feedback and coaching.

The Growing Impact of HAIs on Hospital Reimbursements

In 2008, the CMS stopped providing reimbursement for expenses related to certain HAIs, including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI) and surgical site infections (SSI). According to a 2009 report from the Centers for Disease Control and Prevention (CDC), HAIs cause up to $40 billion per year in excess costs. The Patient Protection and Affordable Care Act created additional reporting requirements and further increased the financial impact of HAIs with three new programs.

Value-Based Purchasing, Readmissions Reduction and Hospital-Acquired Condition (HAC) Reduction

Under the Value-Based Purchasing program (VBP), the CMS withholds a gradually increasing portion of up to 2% of baseline Diagnosis-Related Group (DRG) payments. Hospitals with high readmission rates (which are impacted by HAIs) can face an additional penalty of up to 3%, and another 1% is withheld from hospitals in the worst-performing quartile of the HAC scoring system, based on:

  • Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSI) 90 Composite
  • CDC and National Healthcare Safety Network (NHSN) measures of CAUTI, CLABSI and SSI 
To earn back withheld funds or increased payments, hospitals must perform well on a Total Performance Score (TPS) based on clinical quality indicators and patient satisfaction measures.

Improving Hand Hygiene Monitoring Is Critical to Helping Prevent HAIs 

Hospital employees’ hand hygiene performance is critical to avoiding CMS penalties and other HAI-related costs. Multiple studies have shown that structured, long-term hand hygiene programs are effective in helping to reduce HAI rates. 

For example, a study published in Lancet found that a multi-modal intervention including increased access to alcohol-based hand sanitizer and regular performance feedback resulted in a 42% reduction in the overall prevalence of healthcare-associated infections.1

In another study, a hospital-wide hand hygiene promotion strategy improved the facility’s compliance rate from 20% to 61% over a three-year period—and reduced the frequency of healthcare-associated MRSA infections by 50%.2

A multifaceted program studied in the American Journal of Infection Control increased hand hygiene compliance from 38% to 65% over four years, resulting in decreased rates of MRSA, VAP, CLABSI and CAUTI.3

SMARTLINK™ Technology Is a Reliable Tool for Monitoring and Improving Hand Hygiene 

Hospitals need structured, reliable programs and monitoring tools to sustain compliance with recommended hand hygiene practices and fight against the spread of HAIs. 

Research has shown that compliance rates are frequently overstated in official figures due to the Hawthorne Effect induced by direct observation. A recent study utilizing an electronic monitoring system showed that hand hygiene rates are temporarily inflated up to 300% in the presence of an observer—and quickly return to normal when the observer leaves the area.4  Other issues with direct observation include small sample sizes,5  potential biases and time-consuming manual reporting. 

The SMARTLINK™ Activity Monitoring System reduces these obstacles by running 24/7 and silently monitoring all hand hygiene opportunities and activities in a floor, unit or room. Once a baseline measurement is established, infection preventionists can use to track compliance metrics in real-time with 98% accuracy.6

SMARTLINK™ Technology offers far more than compliance monitoring—it is a total solution that combines trusted hand hygiene products, integrated technology and peer-level clinical support in a flexible, modular system. Contact GOJO today to learn more about how SMARTLINK™ Technology helps hospitals fight HAIs and protect hard-earned reimbursements.


1 Pittet et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet, 2000, 356:1307-1312
2 Ling et al. Impact of a hospital-wide hand hygiene promotion strategy on health-care associated infections.  Antimicrobial Resistance and Infection Control, 2012, 1:13.
3 Jaffar et al. Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections. American Journal of Infection Control, 2013, 41(6):482-486.
4 Srigley et al. Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. BMJ Quality & Safety Journal. 2014.
5 Fries et al. Monitoring Hand Hygiene via Human Observers: How Should We Be Sampling? Infection Control and Hospital Epidemiology July 2012. Vol 33 (7) 689-695.
6 GOJO Industries, Inc., Functional - Compliance Systems, LUX SMARTLINK System Accuracy Lab Testing, 26 September 2014.

Add your comment

Name Email Comment

View Blog By Author +


Contact Information

Contact: Kelly Ward-Smith, Public Relations Senior Manager

Phone Number: 330-255-6293
Mobile Phone: 330-819-8638

Email: SmithKe@GOJO.com

This contact information is for news media only. For other inquiries, please contact GOJO customer service at 1-800-321-9647 or use the GOJO Contact Us form.