Thanks @Meleesa, it has some interesting tech! This approach would be relevant for institutional settings, but less so for household level (and unfortunately this one would be too $$$ for my application).

I'll keep looking for low-cost household approaches and update here with anything interesting. Meanwhile, this article summarises some of the different technology:

Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology

Background
Hand hygiene is one of the most effective ways of preventing health care–associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality.

Objective
This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems.

Methods
A systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author.

Results
In total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7%), camera-assisted observation (10/73, 14%), sensor-assisted observation (29/73, 40%), and real-time locating system (32/73, 44%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33%).

Conclusions
Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene–related issues.

Hi Ian, I have come across this article which may provide some insights, if you have not seen it already.
A Hand Hygiene Tracking System With LoRaWAN Network for the Abolition of Hospital-Acquired Infections
ieeexplore.ieee.org/document/10054565
Thanks and best wishes
Meleesa

Dear Paresh,

I've made some edits to the original post in response to your questions. From what I've read, observation of handwash events is the gold standard. But it's also expensive to implement, and impinges on people's privacy. Observing presence/absence of soap and water gives only an indication that handwashing might be happening.

Some of the sensors I've read about are triggered by i) action (e.g. pumping a soap dispenser); ii) movement (e.g. vibration from using a sink, or picking up a soap bar); or iii) proximity (e.g. a healthcare worker approaches a sink and it logs an event when a device the worker is wearing talks to the sensor at the handwashing sink). The sensors have a counter and sometimes a time stamp for the number of times handwashing events occurred.

In the case of our study, we'd likely do a count of handwashing events before and after the intervention. I think this would be enough to indicate if the intervention had some success. If we wanted to go further, we'd look closely (observations) at a sample of households at what % of handwashing events were correlated with before eating, after defecating etc. And/or look at changes in health after the intervention.

Regards,
Ian

Welcome to SuSanA, Ian. That sounds like a very interesting study.

Could you please elaborate on what you are planning to monitor? I mean are you planning to monitor handwashing after the use of the toilet, meal times, or anything else? for the former, curious about how the use of toilets itself will be monitored. Also, curious if sensors would detect the use of soap. 

Further, please let us know a little about the geography of the proposed study. That will enable others working in the region to connect.

Kind regards
paresh 

Dear SuSanA community,

Have any of you had experience with using sensors to monitor handwashing activity in low- middle- income country contexts? Do you have recommendations of technology that you think might be useful that track the number of handwash events?

I'm working on a hygiene program in the Pacific (Nauru in this case) in both schools and households. We're interested in creative ways to monitor changes in handwashing at critical times, particularly after defecating.

I've been reading through papers on sensor technology, particularly tech that tracks # of handwash events. There's several papers related to health care settings in high income countries.  The sensor technology in these is either $$$ or not applicable to a household context.

This study in India used soap dispensers with sensor @ US$25 per unit to track handwashing in households. It's cheap, but it's a wall mounted foaming unit, so unlikely to be the usual soap that households would use, and slightly more complex to install.

Ideally I'd find something affordable, and the soap that forms part of the sensor application is close to what's used in the house already (i.e. pump action ok, or sensors embedded in bars of soap).

I found another study that was using vibration in a sink to 'log' a handwashing event. So there might be other creative ideas that don't just combine sensors+soap.

Thanks in advance for any insights you might have.