Alexander I. Levchenko

Acceptability of a wearable hand hygiene device with monitoring capabilities

Transmisssion of infection within healthcare institutions is a significant threat to patients and staff. One of the most effective means of prevention is good hand hygiene. A research team at Toronto Rehabilitation Institute, Ontario, Canada, developed a wearable hand disinfection system with monitoring capabilities to enhance hand wash frequency. We present the findingsof the first phase of a larger study addressing the hypothesis that an electronic hand hygiene system with monitoring and reminding propertieswill increase hand hygiene compliance. This first phase focused on the acceptability and usability of the wearable electronic hand wash device ina clinical environment. The feedback from healthcare staff to the first prototype has provided evidence for the research team to continue with the development of this technology.

The feasibility of an automated monitoring system to improve nurses' hand hygiene

BACKGROUND Inadequate hand hygiene (HH) by healthcare staff results in increased rates of hospital acquired infections in healthcare institutions, considerable waste of resources, and negative economic impact for the healthcare system. Toronto Rehabilitation Institute has developed an automated HH monitoring system that detects HH opportunities, generates HH reminding signals when it is necessary and enables hospital management to monitor individual and aggregated HH performance on ongoing basis. OBJECTIVE To demonstrate that HH improvement is feasible with the proposed technical solution and that technology is acceptable by potential users. METHODS The technology was installed in four rooms on a nursing unit of a larger complex continuous care hospital. The rooms were selected to make it possible to automatically follow the same nurses for the duration of their entire shift. Eleven nurses were provided with the wearable electronic HH monitors as well as with the instrumented personal wearable alcohol gel dispensers. Stationary gel dispensers installed in the unit were also instrumented with technology. RESULTS Over 145 h of testing the system automatically recorded a total of 1438 events of entering and leaving monitored rooms and indicated an average of 6.42 HH actions per hour. The baseline observational study indicated 4.2 HH actions per hour. Approximately half of the HH actions recorded by the system were performed using personal wearable alcohol gel dispensers. CONCLUSION The results obtained when testing the embedded HH monitoring system demonstrated the feasibility of HH improvement and proved that proposed solution merits a larger and longer clinical trial to measure the degree of improvement and the sustainability of that improvement.

Defining the configuration of a hand hygiene monitoring system.

BACKGROUND Inadequate hand hygiene (HH) by staff leads to hospital-acquired infections, high morbidity, and mortality rates for patients and a growing economic impact. The Toronto Rehabilitation Institute developed a different approach to measure and increase HH frequency, that is, a monitoring system that automatically detects HH opportunities associated with approaching and leaving patient areas. The aim of this study was to collect and classify data on HH opportunities to (1) evaluate the percentage of opportunities that the system could detect and (2) identify the system configuration. METHODS An observational study collected time-stamped data on HH opportunities and methods of nurses on a complex care unit. Data were processed according to the Ministry of Health of Ontario, Canada. The data were subsequently classified corresponding to the motion patterns of nurses to identify areas that need to be controlled by the system. RESULTS A total of 1093 HH opportunities were recorded over 94 hours from 15 nurses, with 919 opportunities associated with entering or leaving patient environments. CONCLUSION The monitoring system would be able to detect and process 85% of HH opportunities in a complex care setting. To process these opportunities, the system configuration should include monitoring of patient room entrances, individual patient environments in multibed rooms, and shared ensuite bathrooms.

Embedded System for Hygiene Compliance Monitoring

Different approaches to implementation of hygiene compliance monitoring are presented. The architecture and operation of an embedded distributed system for hygiene compliance monitoring are described. The performance of the system does not depend on the number of monitored areas, number of caregivers being monitored, and no network infrastructure is required.

The Effect of Automated Monitoring and Real-Time Prompting on Nurses' Hand Hygiene Performance

Adequate hand hygiene compliance by healthcare staff is considered an effective method to reduce hospital-acquired infections. The electronic system developed at Toronto Rehabilitation Institute automatically detects hand hygiene opportunities and records hand hygiene actions. It includes an optional visual hand hygiene status indication, generates real-time hand hygiene prompting signals, and enables automated monitoring of individual and aggregated hand hygiene performance. The system was installed on a complex continuous care unit at the entrance to 17 patient rooms and a utility room. A total of 93 alcohol gel and soap dispensers were instrumented and 14 nurses were provided with the personal wearable electronic monitors. The study included three phases with the system operating in three different modes: (1) an inactive mode during the first phase when hand hygiene opportunities and hand hygiene actions were recorded but prompting and visual indication functions were disabled, (2) only hand hygiene status indicators were enabled during the second phase, and (3) both hand hygiene status and real-time hand hygiene prompting signals were enabled during the third phase. Data collection was performed automatically during all of the three phases. The system indicated significantly higher hand hygiene activity rates and compliance during the third phase, with both hand hygiene indication and real-time prompting functions enabled. To increase the efficacy of the technology, its use was supplemented with individual performance reviews of the automatically collected data.

Distributed IR based technology to monitor hand hygiene of healthcare staff

An electronic system to increase compliance with hand hygiene rules and clinical tests which demonstrated the function and acceptability of the system are described.

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.