Geoffrey Roy Fernie

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.

Hand hygiene monitoring technology: a systematic review of efficacy.

Electronic and video monitoring systems (EMS/VMS) may improve hand hygiene by providing feedback, real-time reminders or via the Hawthorne effect. The aim of this systematic review was to assess the efficacy of EMS/VMS in improving hand hygiene or reducing the incidence of healthcare-associated infection (HCAI). Experimental and quasi-experimental studies were included if they measured any hand hygiene outcome and/or HCAI incidence. Of the studies included, seven used system-defined compliance (SDC) (N = 6) or hand hygiene event rate (N = 1) as their outcome. SDC differed for all systems. Most (N = 6) were single ward studies. Two uncontrolled pretest‒post-test studies evaluating EMS that provided voice prompts showed increases in SDC, but risk of bias was high. Two uncontrolled time-series analyses of VMS that provided aggregate feedback demonstrated large, sustained improvement in SDC and were at moderate risk of bias. One non-randomized controlled trial of EMS with aggregate feedback found no difference in hand hygiene frequency but was at high risk of bias. Two studies evaluated EMS providing individual feedback and real-time reminders. A pretest‒post-test study at high risk of bias showed an increase in SDC. An RCT at low risk of bias showed 6.8% higher SDC in the intervention arm partially due to a fall in SDC in the control arm. In conclusion, the overall study quality was poor. The study at lowest risk of bias showed only a small increase in SDC. VMS studies at moderate risk of bias showed rapid and sustained increases in SDC. Data were insufficient to recommend EMS/VMS. Future studies should prioritize testing of VMS using stronger study designs including control arms and validated, system-independent measures of hand hygiene.

Phase tracking of the breathing cycle in sleeping subjects by frequency analysis of acoustic data

We tested the hypothesis that the inspiratory and expiratory phases of breathing could be identified from breath sound recordings during sleep. Breath sounds were digitally recorded from 10 subjects during sleep. Frequency spectra of inspiration and expiration were determined. The ratio of frequency magnitude bins between 400-1000 Hz to frequency bins between 10-400 Hz was calculated for inspiration (Ri) and expiration (Re) for each breath. The Ri/Re ratio was significantly greater than the thresholds of 1.5 (p < 0.001) and 2-fold (p < 0.001). Breathing phases were correctly identified in 90% and 73% of cases using the 1.5 and 2.0 thresholds, respectively.

Detection of upper airway narrowing via classification of LPC coefficients: Implications for obstructive sleep apnea diagnosis

The similarities between unvoiced speech sounds and turbulent breath sounds were used to detect change in sound characteristics caused by narrowing of the upper airway (UA), similar to that occurring in obstructive sleep apnea (OSA). In 18 awake subjects, UA resistance (RAU), an index of UA narrowing, was measured simultaneously with breath sounds recording. Linear Prediction Coding was applied on turbulent inspiratory sounds drawn from low and high RAU conditions and K-means was used to cluster the resulting coefficients. The resulting 2 clusters were tested for agreement with the underlying RAU status. Distinct clusters were formed when RUA increased relatively high but not in cases with lower rise in RUA (P&#60;0.01 for all indicators.) This is the first work to show the utility of LPC in breath sounds analysis confirmed by an objective indicator or UA narrowing.

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.

High friction on ice provided by elastomeric fiber composites with textured surfaces

Two main applications requiring high friction on ice are automobile tires and footwear. The main motivation behind the use of soft rubbers in these applications is the relatively high friction force generated between a smooth rubber contacting smooth ice. Unfortunately, the friction force between rubber and ice is very low at temperatures near the melting point of ice and as a result we still experience automobile accidents and pedestrian slips and falls in the winter. Here, we report on a class of compliant fiber-composite materials with textured surfaces that provide outstanding coefficients of friction on wet ice. The fibrous composites consist of a hard glass-fiber phase reinforcing a compliant thermoplastic polyurethane matrix. The glass-fiber phase is textured such that it is aligned transversally and protruding out of the elastomer surface. Our analysis indicates that the exposed fiber phase exhibits a “micro-cleat” effect, allowing for it to fracture the ice and increase the interfacial contact area thereby requiring a high force to shear the interface.

Improving Slip Resistance on Ice: Surface-Textured Composite Materials for Slip-Resistant Footwear

Falls present a massive health risk for older adults. Half of those over 80 will fall at least once a year with 1 in 5 suffering a serious injury. Footwear outsole material that provides good grip on ice and snow can potentially prevent many of these injuries. Our team has developed our own promising patent-pending composite outsole materials with a unique structure that consist of soft rubber compound with hard microscopic fibers protruding out from the surface. In this study, we attempt to optimize the ice friction performance of our composite for extended use. We investigate the effect of manufacturing and testing parameters using the Taguchi method for robust design. Our results on optimization of process parameters demonstrate that fiber content at 8% volume fraction with mold temperature sets at 120 °C lead to maximum ice friction properties before and after simulated wear. The optimized composite design showed a higher coefficient of friction (COF) on ice than any on the market now, which highlights the capability of the material to provide improved traction on icy surfaces and prevent fall-related injuries.

Outcomes Rather than Outputs: Collaborative Closed-Loop Design and Commercialization

This paper outlines the Toronto Rehabilitation Institute Technology Teams vision for translational research. The objective of the Technology Team is to help people age successfully by providing tools to manage the disabilities that come with aging. To facilitate this translational research and realizing real world benefits, the Technology Team has developed a collaborative closed-loop design process. We describe the five strategies that make up our approach. The strategies are: 1) Having a collaborative team of clinicians, technical experts, researchers and students; 2) Maintaining prototyping facilities on-site; 3) Using simulators to quickly, safely, and repeatably test ideas with the target population; 4) Building relationships with stakeholders; 5) Careful documentation in preparation of regulatory approvals. Together these strategies have helped our team focus on translating research findings into practical outcomes as the ultimate goal of our research. These outcomes include changes to policy and clinical practice as well as the creation of new products, in addition to the traditional focus of academic research groups on outputs such as publications and grants.