Method for Automated Monitoring of Hand Hygiene Adherence without Radio-Frequency Identification

Abstract

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...

Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

“…80,81 A system developed using active, battery-powered devices that communicate over unused space in the Wi-Fi spectrum to generate sensor contact logs and event time stamps for inference of hand hygiene adherence noted 97% sensitivity and 100% specificity. 82 Another recently developed technology uses a credit card-sized alcohol sensor badge to detect whether a healthcare worker performs hand hygiene with an alcohol-based product: if alcohol is detected within 8 seconds of room entry or exit, the badge responds with a green light and an audible ping; if not, the badge shows red and beeps. 83 C. Using automated systems eliminates the selection and recall bias of human observers and provides a just-in-D.…”

“…85 Tracking systems require wearable devices, sensors, and triggers, all of which must be purchased or reclaimed (ie, old pagers destined for disposal). 82 Systems requiring hardwiring or construction add to the cost of installation and potentially increase the risk of infection from particulates like mold or fungus released during installation. 86 Wireless frequencies must also take into account the unit and bed layout and the potential to interfere with other hospital equipment dependent on Wi-Fi.…”

Monitoring Hand Hygiene via Human Observers: How Should We Be Sampling?

“…Generating this event log required pre-experiment mote calibrations to define RSSI thresholds for identifying the most likely healthcare worker spatial positions for any given timestamp; a more detailed discussion of this approach has been reported previously. [15]…”

“…[5, 7, 8] Furthermore, the reliability of directly observed hand-hygiene audits as a reflection of overall performance can be adversely affected by sporadic or inconsistent sampling. [5] Several new technologies [9, 10, 11, 12, 13, 14, 15] offer alternatives to human observation by using technology to measure or approximate hand-hygiene compliance, but for the near future, hand-hygiene compliance will likely continue to be measured predominantly by human observers in most healthcare settings.…”

Hand hygiene duration and technique recognition using wrist-worn sensors

“…Consider a hospital unit with handwashing solution dispensers which emit messages when activated. One such deployment in the Medical Intensive Care Unit at the University of Iowa Hospitals and Clinics is shown in Figure 1 [5]. The figure shows a network comprised of dispensers and proximity sensors (beacons) that maintain clock synchronization and relay messages to a base station.…”