Wireless Technology Could Boost Hand Hygiene Compliance
Physicians and computer scientists at the University of Iowa have collaborated on a pilot study to create a low-cost "green" wireless technology that automatically tracks the use of hand hygiene dispensers when health care workers enter and exit patient rooms.
The new method of monitoring hand hygiene compliance, which is essential for infection control in hospitals, is being highlighted today at the annual meeting of the Society for Healthcare Epidemiology of America.
"We know that a range of pathogens are spread from health care workers to patients by direct touch and that the current rates of hand hygiene compliance are suboptimal," said the study's lead investigator Philip Polgreen, M.D., assistant professor of internal medicine at the University of Iowa Roy J. and Lucille A. Carver College of Medicine.
"Our new low-cost method of monitoring could potentially reduce costs while increasing compliance rates," added Polgreen, who also holds an appointment in epidemiology in the UI College of Public Health.
The failure of health care workers to perform appropriate hand hygiene is one of the leading preventable causes of infections associated with health care. The new technology represents a major shift from the current method of monitoring hand hygiene compliance. That method involves direct human observation, which is both costly and labor intensive.
With human observation, Polgreen noted, there also is the potential for a so-called "Hawthorne effect," which means workers will only clean their hands when being actively observed. Older, automated monitoring technology, called radio-frequency identification infrastructure, is available, but can be too costly to implement and consumes far more power than the UI method.
The pilot study used ZigBee technology, which is part of a new generation of wireless devices that require less power. Workers wear small, pager-sized badges to monitor their use of hand hygiene dispenser stations prior to entering patient rooms.
The technology behind the study was developed in collaboration with computer scientists at the UI, led by Ted Herman, Ph.D., professor of computer science in the UI College of Liberal Arts and Sciences. Herman's team designed badge construction and placement of small beacons inside patient rooms and other designated locations.
"A novel part of our method is how data is recorded," Herman said, "Data is recorded and processed in the badges rather than relying on a network."
Each use of a dispenser station is automatically reported by the user's badge, which logs the time as well as length of use, date and dispenser ID number. Data from the badges can then be automatically off-loaded multiple times, which means results are recorded and aggregated without any manual data entry.
In the pilot study, the automated monitoring system correctly identified more than 90 percent of study subjects entering and exiting patient rooms when the subjects remained in the room for 30 seconds. When the time in the room increased to 60 seconds, the monitoring system approached 100 percent identification of subjects entering and exiting patient rooms.
The study findings suggest that there is potential for this new technology to change the behavior of health care workers and increase compliance. Polgreen pointed out that more testing in a variety of hospital settings is necessary, but that the technology may offer hospitals a cost-effective option to implement automated monitoring of hand hygiene compliance in accordance with Centers for Disease Control guidelines.
"This new technology is a novel and practical method to determine hygiene compliance that does not rely on the installation of expensive infrastructure and can be installed and removed within minutes," he said.
The development of the technology was funded by an award to Herman from the National Science Foundation. Additional funding was provided by an NIH career grant awarded to Polgreen, as well as a grant from the UI.