Diagnostic accuracy of automated systems for detection of hand hygiene compliance among healthcare workers: a systematic review and meta-analysis

Hand hygiene compliance is essential for preventing healthcare-associated infections and limiting the spread of antimicrobial resistance. Automated electronic monitoring systems have been proposed as possible alternatives to direct observation; however, their diagnostic accuracy remains uncertain. The aim of this systematic review was to evaluate the diagnostic performance of automated systems in detecting hand hygiene compliance among healthcare workers (HCWs). We searched PubMed, EMBASE, Cochrane Library, and Web of Science for studies published from January 2000 through May 2026. Studies were eligible if they compared the accuracy of automated hand hygiene monitoring systems with that of direct observation. A bivariate random-effects model was used to pool sensitivity and specificity. The review followed PRISMA guidelines and was registered in PROSPERO (CRD42022338607). Twenty studies were included in the review, of which seven were eligible for meta-analysis. The included studies evaluated different types of automated electronic hand hygiene monitoring systems, most commonly using room entry and exit events as proxies for hand hygiene opportunities. In terms of diagnostic performance for identifying hand hygiene compliance among HCWs, the pooled sensitivity and specificity were 86% (95% CI: 52–97%) and 98% (95% CI: 83–100%), respectively. Severe between-study heterogeneity was observed in the univariate analyses. Therefore, pooled diagnostic accuracy estimates should be interpreted cautiously. Automated hand hygiene monitoring systems may offer a promising approach for assessing hand hygiene compliance; however, current diagnostic accuracy estimates remain uncertain with substantial between-study heterogeneity. Further well-designed studies using standardized validation methods and transparent reporting of diagnostic accuracy outcomes are needed to clarify how accurately automated systems capture specific elements of hand hygiene compliance.