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Hand hygiene monitoring and real-time prompting system
Abstract
10.1109/SysCon.2012.6189435
... Figure 3 shows the process of searching for and selecting the studies included in the review. All the 89 reviewed studies were published between 2009 and 2020, with 9 (10%) dated in or before 2010 [42,46,56,60,81,83,86,92,113], 38 (43%) dated between 2011 and 2015 [32,33,36,38,39,45,48,49,51,52,54,59,61,[63][64][65]67,68,72,73,[78][79][80]82,84,[87][88][89][93][94][95][96][97][99][100][101]108,116], and 42 (47%) dated in or after 2016 [25,[29][30][31]34,35,37,40,41,43,44,47,50,53,55,57,58,62,66,[69][70][71][74][75][76][77]85,90,91,98,[102][103][104][105][106][107][109][110][111][112]114,115]. Regarding the countries where the studies were conducted, 6 countries had ≥5 studies: United States (31/89, 35%) [25,30,31,36,38,39,41,[46][47][48]51,52,59,61,63,68,69,71,74,76,[80][81][82][83][84]92,95,96,101,107,111], Canada (8/89, 9%) [42,72,[86][87][88][89]98,100], Japan (7/89, 8%) [44,45,55,58,62,114,115], Brazil (6/89, 7%) [32,33,49,56,67,78], Germany (6/89, 7%) [37,40,50,66,108,109], and India (5/89, 6%) [64,65,94,99,102]. ...
... All the 89 reviewed studies were published between 2009 and 2020, with 9 (10%) dated in or before 2010 [42,46,56,60,81,83,86,92,113], 38 (43%) dated between 2011 and 2015 [32,33,36,38,39,45,48,49,51,52,54,59,61,[63][64][65]67,68,72,73,[78][79][80]82,84,[87][88][89][93][94][95][96][97][99][100][101]108,116], and 42 (47%) dated in or after 2016 [25,[29][30][31]34,35,37,40,41,43,44,47,50,53,55,57,58,62,66,[69][70][71][74][75][76][77]85,90,91,98,[102][103][104][105][106][107][109][110][111][112]114,115]. Regarding the countries where the studies were conducted, 6 countries had ≥5 studies: United States (31/89, 35%) [25,30,31,36,38,39,41,[46][47][48]51,52,59,61,63,68,69,71,74,76,[80][81][82][83][84]92,95,96,101,107,111], Canada (8/89, 9%) [42,72,[86][87][88][89]98,100], Japan (7/89, 8%) [44,45,55,58,62,114,115], Brazil (6/89, 7%) [32,33,49,56,67,78], Germany (6/89, 7%) [37,40,50,66,108,109], and India (5/89, 6%) [64,65,94,99,102]. The demographic information of participants was provided in only 70% (62/89) of studies. ...
... Of the 32 studies, 8 (25%) studies adopted infrared-based RTLSs to monitor hand hygiene compliance [72,74,77,[86][87][88][89]98]. An infrared transmitter uses infrared light pulses to transmit a unique infrared code to its receiver, and the receiver can then estimate their relative position inside a building. ...
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.
... Figure 3 shows the process of searching for and selecting the studies included in the review. All the 89 reviewed studies were published between 2009 and 2020, with 9 (10%) dated in or before 2010 [42,46,56,60,81,83,86,92,113], 38 (43%) dated between 2011 and 2015 [32,33,36,38,39,45,48,49,51,52,54,59,61,[63][64][65]67,68,72,73,[78][79][80]82,84,[87][88][89][93][94][95][96][97][99][100][101]108,116], and 42 (47%) dated in or after 2016 [25,[29][30][31]34,35,37,40,41,43,44,47,50,53,55,57,58,62,66,[69][70][71][74][75][76][77]85,90,91,98,[102][103][104][105][106][107][109][110][111][112]114,115]. Regarding the countries where the studies were conducted, 6 countries had ≥5 studies: United States (31/89, 35%) [25,30,31,36,38,39,41,[46][47][48]51,52,59,61,63,68,69,71,74,76,[80][81][82][83][84]92,95,96,101,107,111], Canada (8/89, 9%) [42,72,[86][87][88][89]98,100], Japan (7/89, 8%) [44,45,55,58,62,114,115], Brazil (6/89, 7%) [32,33,49,56,67,78], Germany (6/89, 7%) [37,40,50,66,108,109], and India (5/89, 6%) [64,65,94,99,102]. ...
... All the 89 reviewed studies were published between 2009 and 2020, with 9 (10%) dated in or before 2010 [42,46,56,60,81,83,86,92,113], 38 (43%) dated between 2011 and 2015 [32,33,36,38,39,45,48,49,51,52,54,59,61,[63][64][65]67,68,72,73,[78][79][80]82,84,[87][88][89][93][94][95][96][97][99][100][101]108,116], and 42 (47%) dated in or after 2016 [25,[29][30][31]34,35,37,40,41,43,44,47,50,53,55,57,58,62,66,[69][70][71][74][75][76][77]85,90,91,98,[102][103][104][105][106][107][109][110][111][112]114,115]. Regarding the countries where the studies were conducted, 6 countries had ≥5 studies: United States (31/89, 35%) [25,30,31,36,38,39,41,[46][47][48]51,52,59,61,63,68,69,71,74,76,[80][81][82][83][84]92,95,96,101,107,111], Canada (8/89, 9%) [42,72,[86][87][88][89]98,100], Japan (7/89, 8%) [44,45,55,58,62,114,115], Brazil (6/89, 7%) [32,33,49,56,67,78], Germany (6/89, 7%) [37,40,50,66,108,109], and India (5/89, 6%) [64,65,94,99,102]. The demographic information of participants was provided in only 70% (62/89) of studies. ...
... Of the 32 studies, 8 (25%) studies adopted infrared-based RTLSs to monitor hand hygiene compliance [72,74,77,[86][87][88][89]98]. An infrared transmitter uses infrared light pulses to transmit a unique infrared code to its receiver, and the receiver can then estimate their relative position inside a building. ...
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.
... At the Toronto Rehabilitation Institute, Levchenko et al. [11] designed personal wearable electronic monitors that can identify HH opportunities and record actions taken by healthcare providers (HCPs). These devices receive signals from dispensers when they are activated. ...
... It is designed in a way that also supports real-time interactions with HCPs by notifying them of missed hand hygiene opportunities. RHMNS has much in common with existing systems [1,10,11] , but it can also handle Multi-HCP situations and fine-grained location scenarios when HCPs move from a patient to another in the same hospital room. Another interesting feature is the sending of wireless activation messages by dispensers. ...
Rising infection rates in healthcare is a global issue that causes complications for the patient, extended hospital stay, financial difficulties, and even death. One of the crucial factors that reduce those infections is better hand hygiene. Due to the lack of automated systems that could help monitoring hand hygiene compliance and reporting on collected data, some hospitals use direct observations, surveys, dispensers usage measurements and other such methods to monitor the compliance of care providers. This paper proposes an alternative system that takes advantage of emerging off-the-shelf infrastructures in hospitals, and in particular of Real-Time Location Systems (RTLS) and intelligent hand sanitizer dispensers. Our RTLS-based approach improves upon the current methods by enabling interactions with care providers through notifications when they do not execute expected hand hygiene actions during care processes, even for fine-grained location situations.
... The details of the technical implementation were described previously 19,20 along with the advantages of this distributed system compared with some alternative approaches. ...
... These algorithms probably need to be customized for various clinical settings, and the technology allows a wide range of parameters to be adjusted. As the system features distributed architecture, 20 with independently working individual electronic monitors these adjustments can be easily implemented not only depending on specific requirements of a clinical environment, but even for individual caregivers based on their assignments, preferences, and actual HH performance results. Regular individual feedback and performance review sessions can help to develop these algorithms and identify the areas for improvements. ...
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.
... Above mentioned electronic monitoring techniques merely provide feedback alerting HCWs if they miss performing necessary hand wash. The RFID and other tracking based systems are helpful in identifying locations of HCWs and their visits to hand wash stations [11,15]. None of these methods check if the hand wash is completed by following all seven steps recommended by WHO guidelines [12]. ...
The WHO has recommended ‘frequent hand washing’ as means to curtail the spread of ‘Public Health Emergencies of International Concern.’ Improvement in the seven step hand wash compliance rate has been shown to reduce the spread of hospital acquired infections. Most of the hand hygiene compliance identification systems developed over the years have restricted their focus on tracking the movement of healthcare workers to and from the hand wash station. However, these systems have failed to detect if the seven step hand wash were performed or not. We proposed and implemented a computer vision and artificial intelligence based system to detect seven steps of the hand wash process. We used the Visual Geometry Group-16 (VGG-16) network combined with the Long Short Term Memory (LSTM) module as a classification system. We developed the hand wash database of 3000 videos to train and optimize the parameters of the VGG16-LSTM model. The optimized model detects different steps of handwash with high accuracy and near real time detection ability. This system will prove to be useful for improving hand wash compliance rate and to curb the spread of infectious diseases.
... 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. ...
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.
Confronted with the COVID-19 health crisis, the year 2020 represented a turning point for the entire world. It paved the way for health-care systems to reaffirm their foundations by using different technologies such as sensors, wearables, mobile applications, drones, robots, Artificial Intelligence (AI), Machine Learning (ML) and the Internet of Things (IoT). A lot of domains have been renovated such as diagnosis, treatment, and monitoring, as well as previously unprecedented domains such as contact tracing. Contact tracing, in conjunction with the emergence, spread, and public compliance for vaccines, was a critical step for controlling and limiting the spread of the pandemic. Traditional contact tracing is usually dependent on individuals ability to recall their interactions, which is challenging and yet not effective. Consequently, further development and usage of automated, privacy-preserving, digital contact-tracing was required. As the pandemic is coming to an end, it is vital to collect and learn the effective used technologies that aided in fighting the virus in order to be prepared for any future pandemics and to be aware of any literature gaps that must be filled. This paper surveys state-of-the-art architectures, platforms, and applications combating COVID-19 at each phase of the five basic contact tracing phases, including case identification, contacts identification and rapid exposure notification, surveillance, regular follow up and prevention. In addition, there is a phase of preparation and post-pandemic services for current and needed future technology that will aid in the fight against any incoming infectious diseases.
The implementation of Sensor Network is a vital area of research in achieving accurate data transfer for automated hand hygiene systems. Sensing devices is also called host or end systems, they provide a service to collate data and can access the internet. The investigation of the entire sensors which include Infrared, water, ultrasonic, distance and motion sensor are based on the Internet Protocol Stack. Internet Protocol Stack consist of five layers such as physical, link, network, transport and the application layer, these layers work together to transmit data across the network. Public building is considered vital to be protected from the spread of infection through poor hand hygiene. In this sense an automated system is required to encouraging people to mitigate the spread of infections in such environment. In this context, this paper proposes a Sensor Network Automated Hand Hygiene Systems in public building (SN-AHHS). Sensor Network Automated Hand Hygiene Systems was designed to prevent spread of infection occurring in public building facilities by prompting users. The designed system uses smart devices (sensors and actuators) for SN-AHHS system. Internet of Things (IoT) platform is employed to process and analyze the collected data from these smart devices in the facility. SN-AHHS has been tested and evaluated, the results show that all component can communicate effectively which is vital to activate the require functionality to alert the user to perform good hand hygiene, it means SN-AHHS is activated when the user step into the facility.
Background
MedSense is an electronic hand hygiene compliance monitoring system that provides Infection Control Practitioners with continuous access to hand hygiene compliance information by monitoring Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" guidelines. Unlike previous electronic monitoring systems, MedSense operates in open cubicles with multiple beds and does not disrupt existing workflows.
Methods
This study was conducted in a 6-bed neurosurgical intensive care unit with technical development and evaluation phases. Healthcare workers (HCWs) wore an electronic device in the style of an identity badge to detect hand hygiene opportunities and compliance. We compared the compliance determined by the system and an infection control nurse. At the same time, the system assessed compliance by time of day, day of week, work shift, professional category of HCWs, and individual subject, while the workload of HCWs was monitored by measuring the amount of time they spent in patient zones.
Results
During the three-month evaluation phase, the system identified 13,694 hand hygiene opportunities from 17 nurses, 3 physiotherapists, and 1 healthcare assistant, resulting in an overall compliance of 35.1% for the unit. The per-indication compliance for Moment 1, 4, and simultaneous 1 and 4 were 21.3% (95%CI: 19.0, 23.6), 39.6% (95%CI: 37.3, 41.9), and 49.2% (95%CI: 46.6, 51.8), respectively, and were all statistically significantly different (p < 0.001). In the four 20-minute sessions when hand hygiene was monitored concurrently by the system and infection control nurse, the compliance were 88.9% and 95.6% respectively (p = 0.34), and the activity indices were 11.1 and 12.9 opportunities per hour, respectively. The hours from 12:00 to 14:00 had a notably lower compliance (21.3%, 95%CI: 17.2, 25.3) than nearly three quarters of the other periods of the day (p < 0.001). Nurses who used shared badges had significantly (p < 0.01) lower compliance (23.7%, 95%CI: 17.8, 29.6) than both the registered nurses (36.1%, 95%CI: 34.2, 37.9) and nursing officers (34.0%, 95%CI: 31.1, 36.9) who used named badges.
Conclusion
MedSense provides an unobtrusive and objective measurement of hand hygiene compliance. The information is important for staff training by the infection control team and allocation of manpower by hospital administration.
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 is required. Note to Practitioners-The embedded system for hand hygiene monitoring system was designed to be used in healthcare institutions. The main function of the system is to monitor hand hygiene compliance according to the rules (based on the Ministry of Health and Long-Term Care guidelines) implemented as a part of the system software. The main components of the system are wearable electronic monitors, disinfectant dispensers, and monitored zones installed in the areas essential for hand hygiene compliance.
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.
To evaluate the feasibility of using an electronic hand hygiene surveillance and feedback monitoring device.
A 2-phase pilot study included initial direct observation of hand hygiene practices as part of routine hospital quality assurance (phase I) and subsequent monitoring using an electronic hand hygiene surveillance device (phase II).
A 700-bed tertiary care teaching hospital.
Phase I included a convenience sample of healthcare workers. Phase II included 7 medical interns and 7 registered nurses recruited through email and at work-related meetings.
During phase I, healthcare workers were directly observed at patient room entry and exit during the period April through November 2008. During phase II, hand hygiene data were gathered through indirect observation using the electronic device during a 4-week period in August 2009. Twenty patient rooms were fitted with electronic trigger devices that signaled a reader unit worn by participants when they entered the room, and 70 dispensers for liquid soap or hand sanitizer were fitted with triggers that signaled the reader unit when the dispenser was used. The accuracy of the devices was checked by the principal investigator, who manually recorded his room entries and exits and dispenser use while wearing a reader unit.
During phase I, hand hygiene occurred before room entry for 95 (25.1%) and after room exit for 149 (39.4%) of 378 directly observed patient room visits, for a cumulative composite compliance rate of 32.3%. Among the 378 room visits, 347 (91.8%) involved contact with the patient and/or environment. During phase II, electronic monitoring revealed a cumulative composite compliance rate of 25.5%. The electronic device captured 61 (98%) of 62 manually recorded room entries and 133 (95%) of 140 manually recorded dispensing events.
The electronic hand hygiene surveillance device seems to be a practical method for routinely monitoring hand hygiene compliance in healthcare workers.
Transmisssion of infection within healthcare institutions is a significant threat to patients and staff. One of the most effective means of prevention is good hand hygiene. A research team at Toronto Rehabilitation Institute, Ontario, Canada, developed a wearable hand disinfection system with monitoring capabilities to enhance hand wash frequency. We present the findingsof the first phase of a larger study addressing the hypothesis that an electronic hand hygiene system with monitoring and reminding propertieswill increase hand hygiene compliance. This first phase focused on the acceptability and usability of the wearable electronic hand wash device ina clinical environment. The feedback from healthcare staff to the first prototype has provided evidence for the research team to continue with the development of this technology.
Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of a successful hand hygiene promotion program. Direct observation of care providers by trained personnel is currently considered the gold standard. Advantages include the ability to determine if hand hygiene is being performed at the correct times, establish compliance rates by healthcare worker type, and assess hand hygiene technique. However, observation surveys are time-consuming, permit observation of only a small fraction of all hand hygiene opportunities, and can be influenced by inter-rater reliability. Comparison of compliance rates obtained through observation surveys is problematic due to lack of standardization of criteria for compliance and observation techniques. Self-reporting of compliance is not sufficiently reliable to be useful. Monitoring the usage of hand hygiene products requires much less time and can be performed on an ongoing basis, and is less complicated. However, it does not provide information about the appropriateness and quality of hand hygiene practices or compliance rates by health-care worker type. Furthermore, it is not clear how product usage correlates with compliance established by observational surveys. Electronic methods for monitoring compliance require further evaluation before they can be routinely recommended. Clearly, further research is needed to develop efficient, reliable, and reproducible methods for monitoring hand hygiene compliance.
Inadequate hand hygiene (HH) by staff leads to hospital-acquired infections, high morbidity, and mortality rates for patients and a growing economic impact. The Toronto Rehabilitation Institute developed a different approach to measure and increase HH frequency, that is, a monitoring system that automatically detects HH opportunities associated with approaching and leaving patient areas. The aim of this study was to collect and classify data on HH opportunities to (1) evaluate the percentage of opportunities that the system could detect and (2) identify the system configuration.
An observational study collected time-stamped data on HH opportunities and methods of nurses on a complex care unit. Data were processed according to the Ministry of Health of Ontario, Canada. The data were subsequently classified corresponding to the motion patterns of nurses to identify areas that need to be controlled by the system.
A total of 1093 HH opportunities were recorded over 94 hours from 15 nurses, with 919 opportunities associated with entering or leaving patient environments.
The monitoring system would be able to detect and process 85% of HH opportunities in a complex care setting. To process these opportunities, the system configuration should include monitoring of patient room entrances, individual patient environments in multibed rooms, and shared ensuite bathrooms.
Nosocomial infections (NIs) are a serious patient safety issue. Infection control personnel are responsible for implementing interventions to reduce this risk. The purpose of this systematic review was to audit the published economic evidence of the attributable cost of NIs and interventions conducted by infection control professionals and to evaluate the methods used. Economic evaluation methodology and recommendations for standardization are reviewed.
A search of MEDLINE and HealthSTAR with medical subject headings or text words "nosocomial infections," "infection control," or "hospital acquired infections" cross-referenced with "costs," "cost analysis," "economics," or "cost-effectiveness analysis" was conducted. Published review articles were also searched. Inclusion criteria included articles published between 1990 and 2000 that contained an abstract and original cost estimate and were written in English. Results were standardized into a common currency.
Fifty-five studies were eligible. Approximately one quarter examined NIs in intensive care patients (n = 13). Most studies were conducted from the hospital perspective (n = 48). The costs attributable to bloodstream (mean = 35,367) were the largest.
Increased standardization and rigor are needed. Clinicians should partner with economists and policy analysts to expand and improve the economic evidence available to reduce hospital complications such as NI and other adverse patient/staff outcomes.
To determine whether electronic monitoring of hand hygiene and voice prompts can improve hand hygiene and decrease nosocomial infection rates in a surgical intermediate care unit.
Three-phase quasi-experimental design. Phase I was electronic monitoring and direct observation; phase II was electronic monitoring and computerized voice prompts for failure to perform hand hygiene on room exit; and phase III was electronic monitoring only.
Nine-room, 14-bed intermediate care unit in a university, tertiary-care institution. All patient rooms, utility room, and staff lavatory were monitored electronically.
All healthcare personnel including physicians, nurses, nursing support personnel, ancillary staff, all visitors and family members, and any other personnel interacting with patients on the intermediate care unit. All patients with an intermediate care unit length of stay >48 hrs were followed for nosocomial infection.
Electronic monitoring during all phases, computerized voice prompts during phase II only.
We evaluated a total of 283,488 electronically monitored entries into a patient room with 251,526 exits for 420 days (10,080 hrs and 3,549 patient days). Compared with phase I, hand hygiene compliance in patient rooms improved 37% during phase II (odds ratio, 1.38; 95% confidence interval, 1.04-1.83) and 41% in phase III (odds ratio, 1.41; 95% confidence interval, 1.07-1.84). When adjusting for patient admissions during each phase, point estimates of nosocomial infections decreased by 22% during phase II and 48% during phase III; when adjusting for patient days, the number of infections decreased by 10% during phase II and 40% during phase III. Although the overall rate of nosocomial infections significantly decreased when combining phases II and III, the association between nosocomial infection and individual phase was not significant.
Electronic monitoring provided effective ongoing feedback about hand hygiene compliance. During both the voice prompt phase and post-intervention phase, hand hygiene compliance and nosocomial infection rates improved suggesting that ongoing monitoring and feedback had both a short-term and, perhaps, a longer-term effect.
We describe a battery-powered recording device incorporating a force-sensitive resistor and a microcontroller that records depressions of wall-mounted soap and alcohol gel dispensers. The device has a two-second (2 s) lockout built into it, so that a single record is associated with a single hand-hygiene episode. Recorders were implanted within the wall-mounted dispensers found in two bed areas and the entrance of a 16-bedded intensive care unit. The use of the bed area dispensers was correlated (r) with the dependency of the patient in the open bed area (r=0.5, P<0.01), as assessed using the UK Department of Health critical care minimum data set. Both bed areas and the entrance dispensers showed wide but different fluctuations in use throughout the 24h day. The recording device may help in feedback about soap and gel use for hand-hygiene quality improvement and educational initiatives.
Hand hygiene (HH) compliance among health care workers (HCWs) has been historically low and hampered by poor surveillance methods. This study evaluated the use of an electronic device to measure and impact HH compliance.
The study is a prospective, interventional study in a 30-bed academic medical center hematology unit. Phase I of the study monitored baseline HH compliance, and phase II monitored HH compliance using automatic alerts. The primary outcome measure was HH compliance, and the secondary end point was nosocomial transmission of vancomycin-resistant Enterococcus (VRE).
Eight thousand two hundred thirty-five HH opportunities were measured during the study, with HH compliance improvement from 36.3% at baseline to 70.1% during phase II. The use of audible alerts improved HH compliance for both the day shift (odds ratio [OR], 3.6) and the night shift (OR, 5.9), as well as across rooms with higher HCW traffic (OR, 1.6) and lower HCW traffic (OR, 3.2).
Electronic devices can effectively monitor HH compliance among HCWs and facilitate improved adherence to guidelines. Electronic devices improve HH compliance regardless of time of day or room location. The development of innovative devices to improve HH is required to validate the long-term implications of this methodology.