Abstract Background Approximately 721,800 hospital acquired infections (HAIs) occur annually, generating an estimated $10 billion in provider costs. Proper hand hygiene (HH) prevents HAIs, yet compliance is low. Electronic hand hygiene monitoring systems (EHHMS) are a potential solution, tracking and signaling HH events. Methods We explored adoption of EHHMS in NYS acute care hospitals through a survey and interviews. Trend analysis was used to evaluate the impact of EHHMS on hospital-acquired C. difficile infection (HA-CDI) rates.