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Embedded system for hygiene compliance monitoring. In this distributed architecture, both zone controllers and personal wearable monitors work completely independently without any network or central coordinating unit. The system is easily scalable, its performance does not depend on the number of monitored zones or the number of wearable monitors. 

Embedded system for hygiene compliance monitoring. In this distributed architecture, both zone controllers and personal wearable monitors work completely independently without any network or central coordinating unit. The system is easily scalable, its performance does not depend on the number of monitored zones or the number of wearable monitors. 

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Different approaches to implementation of hygiene compliance monitoring are presented. The architecture and operation of an embedded distributed system for hygiene compliance monitoring are described. The performance of the system does not depend on the number of monitored areas, number of caregivers being monitored, and no network infrastructure i...

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... subsequently developed an alternative low-cost distributed ar- chitecture (shown in Fig. 1) which is free from the above mentioned limitations. In this concept all monitoring and data processing func- tions are embedded in the personal wearable monitors, which allows them to operate completely independently without any network infra- structure and any central control and processing ...

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... This recorded information is used by the badges to produce real-time prompts to wash within a second of crossing the threshold if staff have not washed their hands within the defined time constant of 60 seconds before crossing. 15 Badges prompt the wearer to wash by producing a discrete vibration detectable only by the wearer. This vibration lasts for 20 seconds or until an instrumented soap or ABHR dispenser is used, whichever comes first. ...
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Background: Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organization's "Your 5 Moments" guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations. Methods: An electronic real-time prompting system collected HH data on a musculoskeletal rehabilitation unit for 12 weeks between October 2016 and October 2017. Aggregate and professional group scores and the distributions of individuals' performance within groups were analyzed. Soiled utility room exits were monitored and compared with performance at patient rooms. Duration of patient room visits and the number of consecutive missed opportunities were calculated. Results: Overall, 76,130 patient room and 1,448 soiled utility room HH opportunities were recorded from 98 health care professionals. Aggregate unit performance for patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of hand wash events that occurred while inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty-three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation. Conclusions: Continuous collection of HH data that includes temporal, spatial, and personnel details provides information on actual HH practices, whereas direct observation or dispenser counts show only aggregate trends.
... The operation of this system has been previously reported. [16][17][18] This system was installed on all 5 study units. Electronic badges were assigned to every member of staff and labeled with the name of the user. ...
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Background: Poor hand hygiene by health care workers is a major cause of nosocomial infections. This research evaluated the ability of an electronic monitoring system with real-time prompting capability to change hand hygiene behaviors. Methods: Handwashing activity was measured by counting dispenser activations on a single nursing unit before, during, and after installation of the system. The effect of changing the prompt duration on hand hygiene performance was determined by a cluster-randomized trial on 3 nursing units with 1 acting as control. Sustainability of performance and participation was observed on 4 nursing units over a year. All staff were eligible to participate. Results: Between June 2015 and December 2016, a total of 459,376 hand hygiene opportunities and 330,740 handwashing events from 511 staff members were recorded. Dispenser activation counts were significantly influenced by use of the system (χ2[3] = 75.76; P < .0001). Hand hygiene performance dropped from 62.61% to 24.94% (odds ratio, 0.36; 95% confidence interval, 0.34-0.38) when the prompting feature was removed. Staff participation had a negative trajectory of -0.72% (P < .001), whereas change in average performance was -0.18% (P < .001) per week for the year. Conclusions: Use of electronic monitoring with real-time prompts of 20 seconds' duration nearly doubles handwashing activity and causes handwashing to occur sooner after entering a patient room. These improvements are sustainable over a year.
... This new frequency-modulated sensing paradigm may enable the development of practical graphenebased nanosensors with wireless connectivity for the continuous monitoring of surface chemical events. We have demonstrated in an air exposure-wet treatment cycle that the modulated chemical gating of the proposed graphene field-effect device and the resulting RF output signal may provide reliable diagnoses of different types of treatment options and solvents, providing a promising route toward infection and biometric monitoring 38,39 in healthcare applications. The low maintenance cost and low energy consumption of this smart graphene sensor, with its advantageous hybridization of sensing/frequency-modulation/memory capabilities, are compatible with the demands for distributed and ubiquitous continuous monitoring. ...
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Modern internet of things (IoTs) and ubiquitous sensor networks could potentially take advantage of chemically sensitive nanomaterials and nanostructures. However, their heterogeneous integration with other electronic modules on a networked sensor node, such as silicon-based modulators and memories, is inherently challenging because of compatibility and integration issues. Here we report a novel paradigm for sensing modulators: a graphene field-effect transistor device that directly modulates a radio frequency (RF) electrical carrier signal when exposed to chemical agents, with a memory effect in its electrochemical history. We demonstrated the concept and implementation of this graphene-based sensing modulator through a frequency-modulation (FM) experiment conducted in a modulation cycle consisting of alternating phases of air exposure and ethanol or water treatment. In addition, we observed an analog memory effect in terms of the charge neutrality point of the graphene, V cnp, which strongly influences the FM results, and developed a calibration method using electrochemical gate-voltage pulse sequences. This graphene-based multifunctional device shows great potential for use in a simple, low-cost, and ultracompact nanomaterial-based nodal architecture to enable continuous, real-time event-based monitoring in pervasive healthcare IoTs, ubiquitous security systems, and other chemical/molecular/gas monitoring applications.
... The details of the technical implementation were described previously 19,20 along with the advantages of this distributed system compared with some alternative approaches. ...
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Adequate hand hygiene is often considered as the most effective method of reducing the rates of hospital-acquired infections, which are one of the major causes of increased cost, morbidity, and mortality in healthcare. Electronic monitoring technologies provide a promising direction for achieving sustainable hand hygiene improvement by introducing the elements of automated feedback and creating the possibility to automatically collect individual hand hygiene performance data. The results of the multiphase testing of an automated hand hygiene reminding and monitoring system installed in a complex continuing care setting are presented. The study included a baseline Phase 1, with the system performing automated data collection only, a preintervention Phase 2 with hand hygiene status indicator enabled, two intervention Phases 3 and 4 with the system generating hand hygiene reminding signals and periodic performance feedback sessions provided, and a postintervention Phase 5 with only hand hygiene status indicator enabled and no feedback sessions provided. A significant increase in hand hygiene performance observed during the first intervention Phase 3 was sustained over the second intervention Phase 4, with the postintervention phase also indicating higher hand hygiene activity rates compared with the preintervention and baseline phases. The overall trends observed during the multiphase testing, the factors affecting acceptability of the automated hand hygiene monitoring system, and various strategies of technology deployment are discussed.
... The system we developed at Toronto Rehabilitation Institute features a distributed embedded architecture, 17,18 with all HH monitoring and prompting functions performed by independently operating personal wearable HH monitors, which are not connected by any network. With HH monitoring algorithms defined in the firmware of these microcontroller-based devices, 17 the performance of the system does not depend on the number of caregivers being monitored, the number of instrumented dispensers, or the number of monitored locations. ...
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Adequate hand hygiene compliance by healthcare staff is considered an effective method to reduce hospital-acquired infections. The electronic system developed at Toronto Rehabilitation Institute automatically detects hand hygiene opportunities and records hand hygiene actions. It includes an optional visual hand hygiene status indication, generates real-time hand hygiene prompting signals, and enables automated monitoring of individual and aggregated hand hygiene performance. The system was installed on a complex continuous care unit at the entrance to 17 patient rooms and a utility room. A total of 93 alcohol gel and soap dispensers were instrumented and 14 nurses were provided with the personal wearable electronic monitors. The study included three phases with the system operating in three different modes: (1) an inactive mode during the first phase when hand hygiene opportunities and hand hygiene actions were recorded but prompting and visual indication functions were disabled, (2) only hand hygiene status indicators were enabled during the second phase, and (3) both hand hygiene status and real-time hand hygiene prompting signals were enabled during the third phase. Data collection was performed automatically during all of the three phases. The system indicated significantly higher hand hygiene activity rates and compliance during the third phase, with both hand hygiene indication and real-time prompting functions enabled. To increase the efficacy of the technology, its use was supplemented with individual performance reviews of the automatically collected data.
... A new technology to enhance hand hygiene A team of researchers has developed a novel technology that allows electronic HH monitoring and prompting of staff [18,19]. The system consists of individual worn badges that communicate with sensors installed at room entrances and hand wash stations throughout the unit. ...
... Rather, a focus on understanding why nurses decide to perform or skip HH actions may be of greater importance for the successful implementation of the EMS. For example, some of these reasons to perform or neglect HH could be explored during weekly and monthly educational sessions with the participants, rather than just focusing on a discussion of actual HH compliance rates [18]. ...
... Administrators clearly indicated the potential consequences of using the EMS in the long term as a potential barrier, whereas nursing staff only perceived the immediate outcomes of the system. The lack of nurses' focus on long-term outcomes might indicate that nurses do not realize the capabilities of the system, a problem easily corrected by providing additional information in the recruitment session or during the individualized educational sessions [18]; it might also point to a more serious issue based in a lack of ongoing commitment to improve practice. This phenomenon has been reported by other researchers analyzing quality improvements in nursing practice [32] and results from the current practice development movement focusing on immediate reportable outcomes and the lack of a systematic approach to the practice change. ...
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Background Careful hand hygiene (HH) is the single most important factor in preventing the transmission of infections to patients, but compliance is difficult to achieve and maintain. A lack of understanding of the processes involved in changing staff behaviour may contribute to the failure to achieve success. The purpose of this study was to identify nurses’ and administrators’ perceived barriers and facilitators to current HH practices and the implementation of a new electronic monitoring technology for HH. Methods Ten key informant interviews (three administrators and seven nurses) were conducted to explore barriers and facilitators related to HH and the impact of the new technology on outcomes. The semi structured interviews were based on the Theoretical Domains Framework by Michie et al. and conducted prior to intervention implementation. Data were explored using an inductive qualitative analysis approach. Data between administrators and nurses were compared. Results In 9 of the 12 domains, nurses and administrators differed in their responses. Administrators believed that nurses have insufficient knowledge and skills to perform HH, whereas the nurses were confident they had the required knowledge and skills. Nurses focused on immediate consequences, whereas administrators highlighted long-term outcomes of the system. Nurses concentrated foremost on their personal safety and their families’ safety as a source of motivation to perform HH, whereas administrators identified professional commitment, incentives, and goal setting. Administrators stated that the staff do not have the decision processes in place to judge whether HH is necessary or not. They also highlighted the positive aspects of teams as a social influence, whereas nurses were not interested in group conformity or being compared to others. Nurses described the importance of individual feedback and self-monitoring in order to increase their performance, whereas administrators reported different views. Conclusions This study highlights the benefits of using a structured approach based on psychological theory to inform an implementation plan for a behavior change intervention. This work is an essential step towards systematically identifying factors affecting nurses’ behaviour associated with HH.
... We previously reported [14] on details of implementation and the advantages of the developed HH monitoring system as well as initial findings on acceptability of automated monitoring by healthcare staff [15]. This paper describes improvements that have been made to the technology and the results obtained when testing the system in a complex continuous care setting. ...
... IR emitters transmit the codes which are unique for each zone and include the zone identification number, zone type, location and other information required for monitoring purposes. Usage of IR communication links with regulated intensity allows the monitored areas to be defined with high accuracy [14] and makes performance of the system independent on structural characteristics of the environment. ...
... All wall-mounted dispensers used by the nursing team participating in the study were instrumented with external controllers [14] so the HH actions performed with these dispensers could be recorded and processed by the system. Each participant also had a personal wearable alcohol gel dispenser communicating with a personal wearable electronic monitor, so HH actions performed with the wearable dispensers were also recorded and processed. ...
Article
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Inadequate hand hygiene (HH) by healthcare staff results in increased rates of hospital acquired infections in healthcare institutions, considerable waste of resources, and negative economic impact for the healthcare system. Toronto Rehabilitation Institute has developed an automated HH monitoring system that detects HH opportunities, generates HH reminding signals when it is necessary and enables hospital management to monitor individual and aggregated HH performance on ongoing basis. To demonstrate that HH improvement is feasible with the proposed technical solution and that technology is acceptable by potential users. The technology was installed in four rooms on a nursing unit of a larger complex continuous care hospital. The rooms were selected to make it possible to automatically follow the same nurses for the duration of their entire shift. Eleven nurses were provided with the wearable electronic HH monitors as well as with the instrumented personal wearable alcohol gel dispensers. Stationary gel dispensers installed in the unit were also instrumented with technology. Over 145 h of testing the system automatically recorded a total of 1438 events of entering and leaving monitored rooms and indicated an average of 6.42 HH actions per hour. The baseline observational study indicated 4.2 HH actions per hour. Approximately half of the HH actions recorded by the system were performed using personal wearable alcohol gel dispensers. The results obtained when testing the embedded HH monitoring system demonstrated the feasibility of HH improvement and proved that proposed solution merits a larger and longer clinical trial to measure the degree of improvement and the sustainability of that improvement.
Article
Hand hygiene is the single most important intervention for reducing healthcare associated infections and preventing the spread of antimicrobial resistance. This sentence begins most publications regarding hand hygiene in the medical literature. But why - as we mark 150 years since the publication of Ignaz Semmelweis' landmark monograph on the subject - do we continue to repeat it? One might be tempted to regard it as a truism. However, while tremendous progress has certainly been made in this field, a significant amount of work is yet to be done in both strengthening the evidence regarding the impact of hand hygiene and maximizing its implementation. Hand hygiene cannot yet be taken for granted. This article summarizes historical perspectives, dynamics of microbial colonization and efficacy of hand cleansing methods and agents, elements and impacts of successful hand hygiene promotion, as well as scale-up and sustainability. We also explore hand hygiene myths and current challenges such as monitoring, behavior change, patient participation and research priorities.