Veronique M. Boscart

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.

A communication intervention for nursing staff in chronic care

AIM The paper is a report of a study conducted to evaluate the effect of a brief, focused educational intervention on the quality of verbal interactions between nursing staff and patients in a chronic care facility. BACKGROUND Positive nurse-patient communication in chronic care is crucial to the quality of life and well-being of patients. Despite this, patients are dissatisfied with these interactions and nursing staff indicate the need for additional training. METHOD A repeated-measures design was used to collect data between April 2003 and February 2004, by audiotaping verbal interactions between nursing staff and patients during morning care. Baseline data were analysed and an educational intervention was developed based on the results of the pretest. Five months after the educational intervention, interactions between the same nursing staff and patients were audiotaped. Twenty-seven randomly chosen patients and selected nursing staff participated in the study. Data were analysed using a qualitative comparative method, and a quantification technique was developed to compare the quality of the interactions before and after the intervention. FINDINGS Preintervention interactions were task-oriented, superficial and dominated by nursing staff. Results statistically significantly improved after the intervention was implemented. Nursing staff were less authoritative, used more solution-focused communication and interactions had a statistically significantly higher positive ratio. CONCLUSION Brief interventions can change nursing staffs communication practice and they realized the importance of effective communication as a fundamental component to deliver patient-focused care.

The relationship between care providers’ relational behaviors and residents mood and behavior in long-term care settings

Background: Care providers’ interactions with residents are an important element in long-term care settings. This study aimed at examining the association between care providers’ relational behaviors and affect and mood of residents with dementia over different caregiving situations and with different residents. Methods: This study utilized a repeated-measures design. Thirty-eight residents with a diagnosis of dementia and 35 care providers from three nursing homes in Ontario, Canada, participated in the study. Care providers’ relational behaviors and residents’ mood and affect were assessed using direct observation methods and self-rating scales. Results: The care providers’ relational behavior varied according to the caregiving situation, with the most effective relational behaviors observed during interpersonal interactions and the least effective during mealtimes. Less effective relational behaviors were observed between care providers and residents that were perceived as more resistive to care. In addition, effective relational behaviors were associated with positive mood and affect of the residents. Conclusion: These findings emphasize the importance of acknowledging and enhancing care providers’ relational behaviors when caring for persons with dementia living in long-term care settings.

How Do Charge Nurses View Their Roles in Long-Term Care?

This article explores how registered nurses (RNs) in long-term care (LTC) understand their role as charge nurses. Data are derived from 16 charge nurses employed in 8 facilities in Ontario, Canada. Qualitative methods are used to analyze audiotapings of interviews. The findings reveal a range of dimensions and subdimensions. Charge nurses experience their work as highly complex and unpredictable. Themes that captured the following dimensions of the supervisor role in LTC include (a) against all odds, getting through the day; (b) stepping in work; and (c) leading and supporting unregulated care workers. In addition, analysis within each category reveals a complex intersection between the nurses’ perceptions of the context and their consequent work strategies. The emerging demands placed on supervisors due to the growing complexity of residents, increasing government regulations, and staffing shortages have caused the role of the charge nurse to evolve with little reflection on its impact.

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.

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.