Devices & Technology

New Technology Improving Hand Hygiene Compliance

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By Suzi Birz, principal, HiQ Analytics, LLC, NurseZone editorial board member 

July 2, 2010 - Want to save a patient? Wash your hands. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) agree that health care-associated infections (HCAI) pose a serious disease risk, and can have a significant financial impact on patients and health care systems. Both organizations report that cleaning your hands at the right times and in the right way can save lives.

As simple as the task sounds, recent research indicates that compliance with hand hygiene guidelines is at an unacceptable rate. One of the most recent reports, published in May’s Applied Nursing Research, found that handwashing guidelines are followed roughly 34 percent of the time.

WHO’s “5 moments for Hand Hygiene” are:
• Before patient contact
• Before aseptic task
• After body fluid exposure
• After patient contact
• After contact with patient surroundings

Health care organizations are challenged with measuring adherence to the guidelines, providing feedback to the providers and ultimately increasing compliance.

Recent technology innovations are helping accomplish all of these goals.

The nurses in the neurology intensive care unit at Shands at the University of Florida Medical Center in Gainesville, Fla., have been piloting HyGreen, a product best described as a breathalyzer for the hands.

“A nurse entering a patient room will receive a mild vibration to the badge she is wearing if she has not washed her hands within two minutes,” explained Sarah Andrews, RN. “This vibration makes you aware of your practice and soon you are washing your hands even in areas not monitored by the badge.”

“The vibration is not audible, so patients are not startled by any alarm,” stated Courtney Puentes, RN. “The patients’ reaction has been positive; infections have been in the news and knowing their providers have clean hands increases their trust in the people caring for them.”

The pilot test has had a positive impact on the infection rate and Shands plans to take the technology house-wide. “Our rate, which was below the 25th percentile nationwide before, has steadily dropped to the 5th percentile with some months reporting zero infections,” stated Jeannette Hester, MSN, RN, CCRN, clinical nurse leader.

“The nurses do not have the feeling of Big Brother watching over them,” said Richard Reed BSN, RN, nurse manager. “Hand hygiene has always been a big part of our practice, but HyGreen brings even more emphasis; there is no downside.”

Whether facilities use technology, posters or training to remind clinicians to wash their hands, monitoring hand hygiene compliance can be a time consuming and laborious task.  Now, as the saying goes, “There’s an app for that.”

Researchers and developers at the University of Iowa have recently made available a free hand-hygiene application for the iPhone/iPod Touch called iScrub Lite.

iScrub is now in use on a unit at the University of Iowa Children’s Hospital. Nurse Manager Sherry Lang, RN, MA, CPNP, CNA-BC, explained their pilot of iScrub. “We set a goal to increase hand hygiene compliance and decrease health care associated infections,” explained Lang.

“We were collecting monitoring data by hand and the data analysis activities could delay the results by up to four months,” said Lang. “The app allows for a continuous real-time readout of seven days of monitoring activities.”

“The monitors use iScrub to record observations annotated with time, location and job role and then click ‘Upload Observations’,” said Lang. “The data is sent to a computer which displays our current compliance rates.”

“We monitor hand hygiene for all our clinicians on the unit,” detailed Lang.  “This includes staff nurses, physician staff, medical students and others.”

“The monitors required less than five minutes of training,” explained Lang. “The technology has been well-received and more fun than clipboards.”

“Monitoring was completed once per month by each staff member,” noted Lang. “With the app, we are able to perform monitoring every day, every shift, and not call any attention to it.”

“No concerns have been raised by the patients and family members; they do not notice the use of the app,” said Lang. “However, as the family notices an increase in hand hygiene by the clinical staff, they have increased their own hand hygiene.”

The University of Iowa Hospitals and Clinics hopes to roll this out system-wide.  Plans for improving iScrub are currently underway. Volunteers from other institutions are being sought for participation in an evaluation program to further explore the use of iScrub in healthcare settings.

Compliance with hand hygiene guidelines improves with these reminding and monitoring technologies.

Read more at:
CDC - Hand Hygiene in Healthcare Settings
Shands HealthCare 

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