Abstract
BackgroundMedSense 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.MethodsThis 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.ResultsDuring 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.ConclusionMedSense 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.
Highlights
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 World Health Organization (WHO) “My 5 Moments for Hand Hygiene” guidelines
The underlying 2.4 GHz radio frequency (RF) technology has been tested to comply with Code of Federal Regulations, Title 47, Part 15 related to transmitted power and interference, and previous research conducted in hospitals using the system has not resulted in any observed interference [19]
In contrast to the previously described electronic monitoring devices, which were mainly focused on recording the entries and exits of the healthcare workers (HCWs) and visitors to or from a single room or the measure of frequency of the alcohol or soap dispenser used; our current system can precisely calculate the hand hygiene opportunities in an open cubicle with multiple beds, which is strategically important in promoting infection control practice
Summary
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. The US Institute of Medicine estimated that preventable adverse patient events, including HCAIs, were responsible for 44,000-98,000 deaths annually in the US at a cost of $17-$29 billion [4]. For these reasons, the World Health Organization (WHO) in 2005 initiated the ‘First Global Patient Safety Challenge’ aiming to improve patient safety by promoting hand hygiene in healthcare facilities with a multimodal strategy that included the use of alcohol-based handrub at the point of care [5]. There have been different strategies in enhancing hand hygiene such as our recent introduction of directly observed hand hygiene practice [8,9]. Another commonly adopted strategy has been regular hand hygiene observation with performance feedback, which is rather labor intensive
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