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Hand-hygiene compliance and contacts of health-care workers largely determinethe potential paths of pathogen transmission in hospital wards. We explored howthe combination of data collected by two automated infrastructures based onwearable sensors and recording (i) use of hydro-alcoholic solution and (ii)contacts of health-care workers provide an enhanced view of the risk oftransmission events in the ward. We perform a proof-of-concept observationalstudy. Detailed data on contact patterns and hand-hygiene compliance ofhealth-care workers were collected by wearable sensors over 12 days in aninfectious disease unit of a hospital in Marseilles, France. 10837 contactevents among 10 doctors, 4 nurses, 4 nurses' aids and 4 housekeeping staff wererecorded during the study. Most contacts took place among medical doctors.Aggregate contact durations were highly heterogeneous and the resulting contactnetwork was highly structured. 510 visits of health-care workers to patients'rooms were recorded, with a low rate of hand-hygiene compliance. Both data setswere used to construct histories and statistics of contacts informed by the useof hydro-alcoholic solution, or lack thereof, of the involved health-careworkers. Hand-hygiene compliance data strongly enrich the informationconcerning contacts among health-care workers, by assigning a 'safe' or'at-risk' value to each contact. The global contact network can thus be dividedinto 'at-risk' and 'safe' contact networks. The combined data could be of highrelevance for outbreak investigation and to inform data-driven models ofnosocomial disease spread.

Enhancing the evaluation of pathogen transmission risk in a hospital by merging hand-hygiene compliance and contact data: a proof-of-concept study