Background Hand hygiene (HH) is a critical part of infection prevention in healthcare settings. Hospitals around the world continuously struggle to improve healthcare personnel (HCP) HH compliance. The current gold standard for monitoring compliance is direct observation; however this method is time consuming and costly. One emerging area of interest involves automated systems for monitoring HH behavior such as radiofrequency identification (RFID) tracking systems. Methods To assess the accuracy of a commercially available RFID system in detecting HCP HH behavior, we compared direct observation to data collected by the RFID system in a simulated validation setting and to a real-life clinical setting over two hospitals. Results A total of 1554 HH events were observed. Accuracy for identifying HH events was high in the simulated validation setting (88.5%) but relatively low in the real-life clinical setting (52.4%). This difference was significant (p<0.01). Accuracy for detecting HCP movement into and out of patient rooms was also high in the simulated setting but not in the real-life clinical setting (100% on entry and exit in simulated setting vs. 54.3% entry and 49.5% exit in real-life clinical setting, p<.01). Conclusions In this validation study of an RFID system, almost half of the HH events were missed. More research is necessary to further develop these systems and improve accuracy prior to widespread adoption.

Elevated blood pressure is a highly prevalent condition that is etiologically related to coronary heart disease and stroke, two of the leading causes of morbidity and mortality throughout the world. Excess salta (sodium chloride) intake is a major determinant of elevated blood pressure. In this paper we discuss the scientific rationale for population-wide salt reduction, the types and strength of available evidence, policy-making on dietary salt in the United States and other countries, and the role and impact of key stakeholders. We highlight a number of lessons learned, many of which are germane to policy development in other domains.

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BACKGROUND Despite significant advances in technological methods for hand hygiene surveillance, a lack of evidence prohibits comparison of systems to one another or against the current gold standard of direct observation. OBJECTIVE To validate a hand hygiene monitoring technology (HHMT) designed to capture hand hygiene behaviors aggregated at the hospital-unit level (GOJO Industries, Akron, OH). METHODS Our team followed a rigorous validation approach to assess the sensitivity and positive predictive value (PPV) of an HHMT. A planned path was first used to measure the accuracy of the system when purposefully activated by investigators. Next, behavioral validation was used to quantify accuracy of the system in capturing real-world behaviors. RESULTS During the planned path phase, investigators performed 4,872 unique events across 3 distinct hospital buildings varying in size and age since construction. Overall sensitivity across the medical center was 88.7% with a PPV of 99.2%. During the behavioral validation phase, trained direct observers recorded 5,539 unique events across 3 distinct hospital buildings. Overall sensitivity across the medical center was 92.7% and PPV was 84.4%. CONCLUSION Objective measures of sensitivity and PPV indicate the promise of the benefit of this and other HHMTs to capture basic behaviors associated with hand hygiene. Infect Control Hosp Epidemiol 2017;38:348-352.

devices for killing of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), or Clostridium difficile spores. 1 The caveat of our findings is that the 2 devices utilized an equivalent light source (low-pressure mercury gas bulbs) and power supply, and they delivered an equivalent radiant dose. However, not all UV devices deliver similar wavelengths of light or the same strength of radiant dose. UV radiation has peak germicidal effectiveness in the wavelength range from 240 to 280 nm. 2-5 Most UV devices use lowpressure mercury gas bulbs that primarily emit UV-C at 254 nm, but recently pulsed xenon flash bulbs have also been incorporated into disinfection systems. Xenon gas bulbs produce a broad spectrum of radiation that encompasses the UV (100-280 nm) and visible (380-700 nm) spectra. 6-8 In a subsequent study, we evaluated the efficacy of a pulsed-xenon device for reducing hospitalacquired pathogens on surfaces in hospital rooms. 9 While the pulsed-xenon device did significantly reduce recovery of C. difficile, VRE, and MRSA from frequently touched surfaces, it was significantly less effective than a low-pressure mercury device in reducing pathogen recovery on glass slides with equivalent exposure time, inoculum, organic load, distance from device, etc. 9 These findings suggest that not all UV devices are equally effective. Clearly, there is a need for direct comparisons of devices, but the cornerstone to comparing UV-C devices is standardized methodology. We recently demonstrated that variation in test methods could significantly impact the performance of UV-C devices. 10 Factors such as increasing the surface area of inoculum spread, orientation of the carriers, and changes in the formulation of organic load greatly impacted the level of killing achieved (in some cases by >2 log 10 CFU, or 99%). 10 These findings have significant implications for the consumers of UV technologies. Without uniform testing methods, there is no baseline for the interpretation of percent or log reduction of pathogens. These examples reiterate the need for a universal set of testing guidelines to be developed by the EPA. The efficacy of UV-C irradiation for killing pathogens is not in question, nor is the importance of testing these types of technology for reducing pathogens on hospital surfaces. However, due to the speed with which new UV-C devices are entering the market, peer-reviewed studies and standardized guidelines have fallen behind. We agree with Cowan that there is a need for uniform standards for testing the efficacy of UV-C devices. This deficiency should be addressed by regulatory agencies and the scientific community. Finally, there is a need for high-quality studies to determine whether use of UV-C devices reduces healthcare-associated infections. Currently, no published randomized trials have demonstrated that UV-C disinfection is beneficial as an adjunct to standard cleaning and disinfection. acknowledgments Financial support. This work was supported by the Department of Vete...