Automated Hand Hygiene Monitoring System Research Articles

Sample sizes for estimating the sensitivity of a monitoring system that generates repeated binary outcomes with autocorrelation.

Sample size formulas are provided to determine how many events and how many patient care units are needed to estimate the sensitivity of a monitoring system. The monitoring systems we consider generate time series binary data that are autocorrelated and clustered by patient care units. Our application of interest is an automated hand hygiene monitoring system that assesses whether healthcare workers perform hand hygiene when they should. We apply an autoregressive order 1 mixed effects logistic regression model to determine sample sizes that allow the sensitivity of the monitoring system to be estimated at a specified confidence level and margin of error. This model overcomes a major limitation of simpler approaches that fail to provide confidence intervals with the specified levels of confidence when the sensitivity of the monitoring system is above 90%.

Effects of data-driven feedback on nurses' and physicians' hand hygiene in hospitals – a non-resource-intensive intervention in real-life clinical practice

Hand hygiene (HH) by healthcare workers (HCWs) is one of the most important measures to prevent hospital-acquired infections. However, HCWs struggle to adhere to HH guidelines. We aimed to investigate the effect of a non-resource intensive intervention with group and individual feedback on HCWs HH in a real-life clinical practice during the COVID-19 pandemic. In 2021, an 11-month prospective, interventional study was conducted in two inpatient departments at a Danish university hospital. An automated hand hygiene monitoring system (Sani Nudge™) was used to collect data. HH opportunities and alcohol-based hand rub events were measured. Data were provided as HH compliance (HHC) rates. We compared HHC across 1) a baseline period, 2) an intervention period with weekly feedback in groups, followed by 3) an intervention period with weekly individual feedback on emails, and 4) a follow-up period. We analyzed data from physicians (N=65) and nurses (N=109). In total, 231,022 hygiene opportunities were analyzed. Overall, we observed no significant effect of feedback, regardless of whether it was provided to the group or individuals. We found a trend toward a higher HHC in staff restrooms than in medication rooms and patient rooms. The lowest HHC was found in patient rooms. The automated hand hygiene monitoring system enabled assessment of the interventions. We found no significant effect of group or individual feedback at the two departments. However, other factors may have influenced the results during the pandemic, such as time constraints, workplace culture, and the degree of leadership support.

1213. The Effect of a Prospective Intervention Program with Automated Monitoring on Hand Hygiene Performance in Long-term and Acute Care Units at a Veteran Affairs Medical Center

Abstract Background There is emerging evidence that implementation of an automated hand hygiene monitoring system (AHHMS) must be part of a multimodal hand hygiene (HH) program that includes complementary strategies. There are few published studies describing in detail the intervention strategies used with an AHHMS. Methods An AHHMS that provides group HH performance rates (100 x HH product dispenses divided by the number of room entries plus exits) was implemented on two Acute Care (AC) units and six long-term care (LTC) units at a Veterans Affairs Medical Center from March 2021 through April 2022. After a 4-week baseline period and 2.5-week washout period, the 52-week intervention period included many components, such as weekly huddles, unit nurse manager engagement, vendor provided clinician-based training and feedback, leadership support, unit recognition, signage and development of a new slogan to remind colleagues to perform HH. Statistical analysis was performed with a Poisson general additive mixed model. Results During the 4-week baseline period, the median HH performance rate was 18.6 (95% CI: [16.5, 21.0]) for all 8 units. During the intervention period, the median HH rate increased to 21.6 [19.1, 24.4], and during the last 4 weeks of the intervention period (exactly 1 year after baseline), the 8 units exhibited a median HH rate of 25.1 [22.2, 28.4], (p < 0.0001) [Figure 1]. The median HH rate increased from 17.5 to 20.0 (p < 0.0001) in LTC units and from 22.9 to 27.2 (p < 0.0001) in AC units. The intervention increased the use of hand sanitizer from 57.5% during baseline to 65.1% (p < 0.0001). The increase in HH rates was due to HH events increasing from 88,758 dispenses during the baseline to 123,722 dispenses during the last 4 weeks of the intervention. Direct observation results during the same periods showed HH compliance ranging from 61-86%. Figure 1- Monthly Hand Hygiene Performance Rates for all Units The green curve shows the change in the median HH rate during the intervention period compared to the baseline and washout periods, with vertical bars showing 95% confidence intervals for the monthly HH rate. Conclusion The intervention increased hand sanitizer usage and HH performance rates for all units. AC units were consistently better than LTC units, which have more visitors and more mobile veterans. Further HH improvement will rely on continued implementation of complementary strategies and long-term monitoring. Disclosures James W. Arbogast, PhD, GOJO Industries, Inc.: employee Pamela Wagner, RN MSN CPPS, GOJO Industries, Inc: Employee of GOJO Gregory A. Robbins, BS, GOJO Industries, Inc.: Current employee of GOJO Industries, Inc. Albert E. Parker, PhD, GOJO Industries: Advisor/Consultant John M. Boyce, MD, Diversey: Advisor/Consultant|Diversey: Expert Testimony|Diversey: Travel support|GOJO Industries: Advisor/Consultant|GOJO Industries: Expert Testimony|GOJO Industries: Travel support|Sodexo Healthcare: Advisor/Consultant.

Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic

BackgroundHealthcare workers’ (HCWs) adherence to hand hygiene is vital in combatting COVID-19 in hospitals. We aimed to investigate HCWs hand hygiene compliance before and during the COVID-19 pandemic and hypothesised that hand hygiene compliance would increase during the pandemic.MethodsWe conducted a prospective observational study in three medical departments at the Regional Hospital of West Jutland, Denmark from April 2019 to August 2020. A total of 150 HCWs participated before the COVID-19 pandemic and 136 during the pandemic. Hand hygiene observations were assessed using an automated hand hygiene monitoring system. Students unpaired t-test was used to assess differences in hand hygiene compliance rates in each department.ResultsComparison analyses showed, that hand hygiene compliance in department A and B was significantly higher before the COVID-19 pandemic than during the pandemic; a 7% difference in department A and a 5% difference in department B. For department C, the total hand hygiene compliance was unchanged during the pandemic compared to before.ConclusionThe COVID-19 pandemic did not raise hand hygiene compliance. Further studies are needed to verify these findings and further identify barriers to hand hygiene compliance among HCWs.

Clinical Evaluation with Automated Hand Hygiene Monitoring System: A Prospective Observational Study on Compliance Improvement Using Feedback Data

Background Hand hygiene compliance (HHC) among healthcare workers (HCWs) remains suboptimal. Hand hygiene (HH) among HCWs is regarded one of the most effective measures to reduce healthcare-associated infections. We aimed to evaluate HH improvement in HCWs using an automated monitoring system to provide systematic feedback on staff HHC. Methods A prospective observational study was conducted in a Danish medical hospital ward (23 beds) between February-November 2020. Sensors were placed on alcohol-based sanitizers, HCW name tags, and patient beds. The sensors measured HH opportunities and sanitizations to be able to provide compliance feedback to staff groups and individuals. Baseline data were obtained before the reporting of feedback data. HCWs were grouped as caregivers (n=58) and doctors (n=18). Rooms were classified by type e.g., medication room and patient room. Overall data was regularly presented to the staff group and subgroups, caregivers, and doctors. Student's t-test was used for comparisons. A two-tailed value of p Results Baseline was performed twice (at weeks 4 and 5 because the COVID19 pandemic interrupted the study for a period). Both baselines showed similar initial compliance among HCW. Baseline HHC was lowest before patient contact (BPC) compared to after patient contact (APC) for both the doctors (16% vs. 26%) and the nurses (22% vs. 39%). Once data were shown and feedback provided, both the doctors (BPC: 16% vs. 24%, p=0.014; APC: 26% vs. 35% p=0.059) and caregivers (BPC: 22% vs. 37%, p Conclusions Feedback data from the automated hand hygiene monitoring system helped the HCWs to improve their HHC significantly.

Hand Hygiene Compliance Rate During the COVID-19 Pandemic

This quality improvement study assesses hand hygiene compliance rates in a hospital with an automated hand hygiene monitoring system during the COVID-19 pandemic.

New Contact Sensorization Smart System for IoT e-Health Applications Based on IBC IEEE 802.15.6 Communications.

This paper proposes and demonstrates the capabilities of a new sensorization system that monitors skin contact between two persons. Based on the intrabody communication standard (802.15.6), the new system allows for interbody communication, through the transmission of messages between different persons through the skin when they are touching. The system not only detects if there has been contact between two persons but, as a novelty, is also able to identify the elements that have been in contact. This sensor will be applied to analyze and monitor good follow-up of hand hygiene practice in health care, following the “World Health Organization Guidelines on Hand Hygiene in Health Care”. This guide proposes specific recommendations to improve hygiene practices and reduce the transmission of pathogenic microorganisms between patients and health-care workers (HCW). The transmission of nosocomial infections due to improper hand hygiene could be reduced with the aid of a monitoring system that would prevent HCWs from violating the protocol. The cutting-edge sensor proposed in this paper is a crucial innovation for the development of this automated hand hygiene monitoring system (AHHMS).

The impact of COVID-19 pandemic on hand hygiene performance in hospitals

BackgroundAchieving high levels of hand hygiene compliance of health care personnel has been an ongoing challenge. The objective of this study was to examine the impact of the COVID-19 pandemic on hand hygiene performance (HHP) rates in acute care hospitals.MethodsHHP rates were estimated using an automated hand hygiene monitoring system installed in 74 adult inpatient units in 7 hospitals and 10 pediatric inpatient units in 2 children's hospitals. A segmented regression model was used to estimate the trajectory of HHP rates in the 10 weeks leading up to a COVID-19-related milestone event (eg, school closures) and for 10 weeks after.ResultsThree effects emerged, all of which were significant at P < .01. Average HHP rates increased from 46% to 56% in the months preceding pandemic-related school closures. This was followed by a 6% upward shift at the time school closures occurred. HHP rates remained over 60% for 4 weeks before declining to 54% at the end of the study period.ConclusionsData from an automated hand hygiene monitoring system indicated that HHP shifted in multiple directions during the early stages of the pandemic. We discuss possible reasons why HHP first increased as the pandemic began and then decreased as it progressed.

Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections.

Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections. This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center. The preintervention period was January 2015 through June 2016. Baseline electronic hand hygiene data collection took place from April through June 2016. The intervention period was July 2016 through December 2017. An electronic hand hygiene system was installed in 4 locations in our hospital. Performance improvement strategies were implemented that included education, troubleshooting, data dissemination, and feedback. Adherence rates were tracked over time. Rates of hospital-acquired infections were evaluated in the intervention units and in control units selected for comparison. The intervention period was subdivided into the initial and subsequent 9-month periods and were compared to the baseline period. Electronically measured hand hygiene rates improved significantly from baseline to intervention, from 47% 77% adherence. Rates >70% continued to be measured 18 months after the intervention. Interrupted time series analysis indicated a significant effect of hand hygiene on healthcare facility-onset Clostridioides difficile infection rates during the first 9 months of the intervention. This trend continued during the final 9 months of the intervention but was nonsignificant. No effects were observed for other hospital-acquired infection rates. Implementation of electronic hand hygiene monitoring and performance improvement interventions resulted in reductions in hospital-onset Clostridioides difficile infection rates.

592. Assessment of Time Spent in the Room by Nurses and Nursing Assistants on a Pediatric Ward by Patient Isolation Status and Demographics

BackgroundPublished reports have raised concern that RNs spend less time in hospital rooms of patients requiring isolation precautions. Other patient-related factors including race/ethnicity, primary language, and socio-economic factors reportedly influence the mean time spent in the room by RNs and certified nursing assistants (CNAs). At a children’s hospital the automated hand hygiene monitoring system (AHHMS) has motion sensors that detect patient room entry and exit and sensors that detect hand hygiene events. Time spent in patient rooms by RNs and CNAs was examined using AHHMS data captured for patients on a 24-bed pediatric hospital ward for multiple patient characteristics to evaluate factors influencing the duration of visits.MethodsRNs and CNAs routinely wore badges with infrared signal technology to monitor hand hygiene compliance, generating time-stamped data for room entries and exits, identified by user job category. Over a 30 day period, April 2016, RN and CNA time in the room was compared by patient characteristics including: length of stay, white yes/no, Hispanic yes/no, interpreter needed yes/no, and isolation status of contact-droplet, contact, or none. Mean minutes spent in the room for RNs and CNAs were evaluated with a random-effects linear model and gamma distribution.ResultsAdmissions for 220 patients occurred in the 24 rooms during the evaluation period; 88 RNs and 28 CNAs completed 18,641 time-stamped room entries and exits. The natural log of patient length of stay (hours) was significantly associated with increased RN and CNA minutes spent in the room (P < 0.001). Interpreter required was not associated with time in the room (P = 0.72), nor was race (P = 0.60), nor was Hispanic ethnicity (P = 0.81). There were no significant differences in time spent in the room for contact, contact-droplet, and no isolation (P = 0.92).ConclusionData derived from infrared signal AHHMS badges can provide insight into RN and CNA care patterns. Isolation status and patient demographics were unrelated to mean RN and CNA time in the room. Patient length of stay was the only predictor of increased nursing time spent providing direct patient care. These results contrast with previous reports demonstrating fewer nursing interactions based on patient demographics or isolation.Disclosures All authors: No reported disclosures.

Impact of an automated hand hygiene monitoring system and additional promotional activities on hand hygiene performance rates and healthcare-associated infections.

Determine the impact of an automated hand hygiene monitoring system (AHHMS) plus complementary strategies on hand hygiene performance rates and healthcare-associated infections (HAIs). Retrospective, nonrandomized, observational, quasi-experimental study. Single, 93-bed nonprofit hospital. Hand hygiene compliance rates were estimated using direct observations. An AHHMS, installed on 4 nursing units in a sequential manner, determined hand hygiene performance rates, expressed as the number of hand hygiene events performed upon entering and exiting patient rooms divided by the number of room entries and exits. Additional strategies implemented to improve hand hygiene included goal setting, hospital leadership support, feeding AHHMS data back to healthcare personnel, and use of Toyota Kata performance improvement methods. HAIs were defined using National Healthcare Safety Network criteria. Hand hygiene compliance rates generated by direct observation were substantially higher than performance rates generated by the AHHMS. Installation of the AHHMS without supplementary activities did not yield sustained improvement in hand hygiene performance rates. Implementing several supplementary strategies resulted in a statistically significant 85% increase in hand hygiene performance rates (P &lt; .0001). The incidence density of non-Clostridioies difficile HAIs decreased by 56% (P = .0841), while C. difficile infections increased by 60% (P = .0533) driven by 2 of the 4 study units. Implementation of an AHHMS, when combined with several supplementary strategies as part of a multimodal program, resulted in significantly improved hand hygiene performance rates. Reductions in non-C. difficile HAIs occurred but were not statistically significant.

Automated monitoring: a potential solution for achieving sustainable improvement in hand hygiene practices.

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.

Near Real-Time Electronic Feedback to Improve Hand Hygiene Adherence

35%. The second unit has shown a 10.51% increase in “Always” response since installation along with 54% increase in dispensing, an 89% increase in HH compliance and a 22% decrease in NIMs. The 2013 savings in NIM for the combined units was $46,150 in direct cost, $31,954 loss and 52.4 days avoided. CONCLUSIONS: Hospital leaders leveraged the electronic messaging capabilities provided in this automated hand hygiene monitoring system to improve hand hygiene performance and positively affect patient perception of caregiver behavior. The survey tool measurement reflected the increased patient satisfaction and the increased HH compliance reduced costs associated with infections.

Increased Hand Hygiene Performance Decreases Nosocomial Infection Markers and Cost After the Implementation of an Automated Hand Hygiene Monitoring System

Increased Hand Hygiene Performance Decreases Nosocomial Infection Markers and Cost After the Implementation of an Automated Hand Hygiene Monitoring System

The Effects of Executive Involvement, Goal Setting, Targeted Education and Caregiver Recognition on Hand Hygiene Performance

Based upon the challenges of improving and sustaining hand hygiene compliance through conventional means, increasing regulatory requirements and a desire to improve patient care, this 145 bed acute care Medical Center decided to implement and evaluate an automated hand hygiene monitoring system. The objective of the study was to measure the impact of automated hand hygiene monitoring system deployment on hand hygiene solution dispensing, hand hygiene compliance and infection rates before and after executive intervention. The initial implementation and application of technology alone, however, did not yield the desired results.

Education Excellence in Scope Reprocessing to Improve Patient Safety

denominator data. The results offered little insight beyond direct observation and it was impossible to generalize our findings to the entire staff and/or all hand cleansing opportunities. The findings also could have been affected by observer bias and by changes in caregiver behavior based on the knowledge that they were being observed. With this in mind, we began to seek other opportunities and technologies to help us with these challenges. PROJECT: We installed an automated hand hygiene monitoring system in the 29-bed 4 North medical-surgical unit. We monitored 29 soap dispensers and 31 alcohol-based hand rub (sanitizer) dispensers in patient rooms using communication units and radiofrequency identification (RFID) tags. We also monitored 6 hallway sanitizer dispensers and 1 sanitizer dispenser in a storage room. In June 2012, we distributed tags and educated five staff members from three departments on 4 North to validate system performance. In July 2012, we tagged and educated 34 more employees on 4 North. Hand-hygiene solution dispensing, hand-hygiene compliance and healthcare-associated infection (HAI) rates were measured from June 2012 through November 2012. In October 2012, newly hired employees were tagged and all tagged staff was reeducated. RESULTS: In June, hand-hygiene compliance among the initial five staff members was 67%. In July 2012, compliance dropped to 46% after giving tags to another 34 personnel. There was a 26.3% increase (20,188-25,502) in alcohol-based hand rub (sanitizer) dispenses and a 23.4% increase in total hand hygiene solution dispenses (21,861-26,977) when compared the first and second months of using the system. With continued education and feedback, hand-hygiene compliance rose to 58.6% in November (MTD November 20, 2012). Hand hygiene compliance for all employees increased 27% (46.1%-58.6%) when comparing the first and last months of compliance monitoring (July-MTD November 20, 2012). For June-August, we had a 50% reduction in nosocomial infection markers (NIMs) compared to the same time period from 2011. This reduction equals an estimated $93,470 direct cost savings, an estimated bottom line impact of $52,060 and 81.2 days of length of stay avoided. LESSON LEARNED: Constant feedback and holding staff members accountable, while recognizing those with excellent performance and frequent patient roomvisits, was vital to compliancewith hand hygiene and improved patient outcomes.

Impact of an Automated Hand Hygiene Monitoring Technology on Hand Hygiene Compliance and Infection Rates

Faced with the challenges of improving and sustaining hand hygiene compliance through conventional means, increasing regulatory requirements and a desire to improve patient safety, Baptist Memorial Hospital Memphis made the decision to evaluate an automated hand hygiene monitoring system. Improvements in aggregate and individual hand hygiene rates were achieved only after the technology had earned clear executive support, visible leadership involvement, goal setting and a caregiver awareness/engagement campaign including individual accountability and transparency with posted weekly reports.

Reproducibility of Results in Decreasing Healthcare-Associated Infections with the Use of Electronic Hand Hygiene Surveillance Technology

Background: Healthcare associated infections (HAIs) cause the loss of thousands of lives and millions of dollars every year despite the widely accepted knowledge that hand hygiene (HH) is the most effective means of reducing HAIs. Clinical managers responsible for one Medical Center's post-surgical unit piloted an automated hand hygiene monitoring system and attained a 22% reduction in HAIs. In order to verify that these results were reproducible, the team expanded deployment of the technology to the Medical Intensive Care Unit (MICU).