Many efforts to automatically measure hand hygiene activity depend on radio-frequency identification equipment or similar technology that can be expensive to install. We have developed a method for automatically tracking the use of hand hygiene dispensers before healthcare workers enter (or after they exit) patient rooms that is easily and quickly deployed without permanent hardware.Monitoring the hand hygiene adherence of healthcare workers (HCWs) and providing performance feedback to HCWs is recommended by the Centers for Disease Control and Prevention, 1 the World Health Organization,2 and the Joint Commission.3 Currently, adherence is commonly measured by direct observation; this approach is considered the gold standard for determining adherence.2 ,4 However, observational surveys are labor-intensive and expensive. 4-6 Also, results are susceptible to observer effects, 7 and their reliability can be affected by sporadic sampling. 8 A number of electronic monitoring systems for hand hygiene have been reported, 4 with more under development. Many efforts to directly measure adherence (ie, as opposed to measuring product usage) depend on radio-frequency identification (RFID) infrastructure or similar technology. Unfortunately, these approaches can be prohibitively expensive, because they require the installation of radio antennas or some other equipment (eg, motion sensors) in areas under study. We have developed a relatively low-cost method for automatically tracking the use of hand hygiene dispensers before HCWs enter (or after they exit) patient rooms that is easily deployed without installation of any permanent hardware or wiring. METHODSOur system consists entirely of small credit-card-sized devices called motes. Motes are active, battery-powered, programmable devices consisting of a small processor, flash memory, and an Institute of Electrical and Electronics Engineers (IEEE) 802.15.4-compliant wireless radio. Each mote is programmed to broadcast a message (ie, a time-stamped identity packet) to other motes. Each message can be received by other motes; from a message one can derive the following information: (1) the identifier of the mote that sent the NIH Public AccessAuthor Manuscript Infect Control Hosp Epidemiol. Author manuscript; available in PMC 2011 December 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript message, (2) the received signal strength, and (3) the time the message was received. These data are recorded on the receiving mote. The motes communicate over unused space in the WiFi spectrum and do not interfere with medical devices.We program our motes to perform 1 of 3 different roles, which we call badges, beacons, and triggers ( Figure 1). Badges are worn by HCWs and are contained in recycled pager cases. Beacons are placed in patient rooms, and triggers are attached to off-the-shelf hand hygiene dispensers. Each of the 3 components is capable of sending wireless messages to the other components and receiving wireless messages from the other component...

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Nosocomial (i.e., hospital-acquired) infections are a major cause of morbidity and mortality in the United States and throughout the world. Therefore, understanding, mediating, and limiting contagious infections are important problems, even in clinical settings. Contact networks of healthcare workers and patients provides a vehicle for modeling the spread of infection, enabling analytical and simulation-based studies. The contact network models are based on geographic maps of hospitals and records of social contact between health care workers and patients. Wireless technology can help in both, geolocating healthcare workers and patients in a hospital and in capturing a record of physical proximity among these agents. As a step towards this goal we have implemented a low-cost wireless system to instrument hand-hygiene events; this system can track the use of hand hygiene dispensers before healthcare workers enter or exit patient rooms.

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