Major articleChallenges in implementing electronic hand hygiene monitoring systems

•Electronic hand hygiene monitoring systems (EHMS) are challenging to implement.•Implementing an EHMS may disrupt physical infrastructure and clinician workflow.•An EHMS should fit the healthcare organization's culture and budget.•Front line workers have concerns about EHMS accuracy and how the data will be used.•Targeted direct observations of HH compliance may be needed to supplement an EHMS.

Electronic hand hygiene (HH) monitoring systems offer the exciting prospect of a more precise, less biased measure of HH performance than direct observation. However, electronic systems are challenging to implement. Selecting a system that minimizes disruption to the physical infrastructure and to clinician workflow, and that fits with the organization's culture and budget, is challenging. Getting front-line workers' buy-in and addressing concerns about the accuracy of the system and how the data will be used are also difficult challenges. Finally, ensuring information from the system reaches front-line workers and is used by them to improve HH practice is a complex challenge. We describe these challenges in detail and suggests ways to overcome them.