The importance of hand hygiene has never been more widely acknowledged than during and after the COVID-19 pandemic. But how well do people really follow good hygiene practices when no one is watching?

To explore this question, researchers from the University of Surrey and the University of South Carolina collaborated with Ecoprod’s partner, the Danish technology company Aguardio, to monitor real-world handwashing behaviour in a hospital setting — using unobtrusive pipe-attached sensors.

Why hand hygiene still matters

In any healthcare environment, proper handwashing is not just a hygiene requirement — it’s a fundamental line of defence against infection. Yet even in hospitals, where expectations are highest, many people still skip this essential step.

Using Aguardio’s innovative Pipe Sensor technology, the research team monitored water usage patterns from toilets and sinks in two public hospital washrooms used by patients and visitors. The aim? To assess how often users actually washed their hands after using the toilet.

Key findings

Over a 19-week period, the sensors recorded 2,636 toilet flushes. Surprisingly — and worryingly — 43.7% of these were not followed by handwashing. On some weeks, the non-compliance rate reached as high as 61.8%.

The study also revealed patterns in behaviour, with lower handwashing rates observed:

• Early in the morning and late in the day
• Around mealtimes (breakfast, lunch, and dinner)

These cyclical trends suggest targeted interventions at specific times could help improve compliance.

How the technology works

The Aguardio Pipe Sensor detects water flow by sensing temperature changes in pipes — a drop or spike in temperature signals that water is moving. By placing sensors on both toilet and sink pipes, the researchers could infer whether users washed their hands based on water activity before and after a flush.

This indirect yet highly effective monitoring method offers hospitals and other facilities a non-intrusive way to understand and ultimately improve hygiene behaviours.

Beyond posters and hand gel

Experts agree: hand hygiene reminders alone are not enough. According to Professor Carrie Newlands, Consultant Surgeon and clinical skills lead at the University of Surrey:

“These findings are worrying but not surprising… In hospitals, lapses like these can have serious consequences. It’s time we move beyond posters and hand gel stations to more effective behavioural strategies.”

Ecoprod and Aguardio: partners in prevention

At Ecoprod, we are proud to work with suppliers like Aguardio, whose smart, data-driven tools empower organisations to improve hygiene, reduce risk and conserve water. From leak detection to behavioural monitoring, Aguardio’s technologies align with our shared goal of smarter, more sustainable washroom solutions.

As this research shows, even the simplest behaviours — like handwashing — can benefit from a smarter approach.

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Read the BBC article covering this story