C ONFIDENTIAL Understanding Electronic Hand Hygiene Monitoring Systems and the Role of the Infection Preventionist Presented by: Tim Cambier 7/13/16

C ONFIDENTIAL Agenda  Learning Objectives  How Technology Lives Within Your Hospital  Understanding the Hand Hygiene Monitoring Landscape  Hand Hygiene Monitoring Technology  Your Role in Selecting a Hand Hygiene Monitoring System – Key Considerations – The Journey of Implementing the Solution – The Impact of Hand Hygiene Monitoring  Q&A

C ONFIDENTIAL Learning Objectives  Understand the role of technology in hospitals  Build literacy on hand hygiene monitoring approaches and technologies  Understand the role of the Infection Preventionist in identifying, implementing, and managing a hand hygiene monitoring solution 3

C ONFIDENTIAL How Technology Lives Within Your Hospital 4 Technology-based initiatives are happening throughout hospitals, at all levels, for various, and sometimes related reasons Using technology to solve one problem can often benefit or lend value to other parts of your organization Key Question: Do we have any of these systems at our facility now? If so, can hand hygiene monitoring be an additional use case or not?

C ONFIDENTIAL How Technology Lives Within Your Hospital - Systems 5 Data Voice Wireless Hardware Software Network Infrastructure Asset Tracking Temp Monitoring Patient Flow Staff Workflow Patient Safety Hand Hygiene Real-Time Locating Systems Staff Assignment Alarm Mgmt. Bed Status Fall Prevention Room Status Nurse Call Physician Orders Patient Records Workflow Mgmt. HL7 Interfaces Billing/Scheduling Electronic Medical Records Staff Access Patient/Staff Safety Video Monitoring Medication Control Wander Monitoring Security and Surveillance Room Sensors Electronic Badges Smart Dispensers Software Servers/Networks Hand Hygiene Compliance

C ONFIDENTIAL How Technology Lives Within Your Hospital - People 6 Information Technology Bio-Med CNO CMO EVS Network Infrastructure Information Technology Bio-Med CMO CNO Infection Preventionist Nursing EVS Quality & Safety Real-Time Locating Systems Information Technology CMO CNO Nursing Quality & Safety Nurse Call Information Technology CMO CNO Nursing Infection Preventionist Physicians Electronic Medical Records Information Technology Bio-Med Nursing Infection Preventionist EVS On-site Security Credentialing Quality & Safety Security and Surveillance Information Technology CMO CNO Infection Preventionist Nursing Quality & Safety Bio-Med EVS Hand Hygiene Compliance

C ONFIDENTIAL SMART Device use in Hospitals 96% of physicians own smartphones and between 56% and 76% own tablets. Multiple studies have shown in- hospital physician smartphone use at approximately 80%. 95% of nurses own a smartphone and 88% of them use smartphone apps at work to get information faster - earlier estimates had assumed only 65% Healthcare professionals are more than wiling to embrace innovations in communications and technology to improve care.

C ONFIDENTIAL Compliance Management Approaches Area/Group Monitoring Person- Specific Monitoring DirectObservationDirectObservation Video Surveillance Cost Impact

C ONFIDENTIAL Understanding the Hand Hygiene Monitoring Landscape Automated Observation Provides easy data collection and reporting via smart device Presents data automatically through software dashboard When combined with an electronic hand hygiene monitoring system it allows for targeted observation Allows for consistent reporting & significant reduction in data transposition errors

C ONFIDENTIAL Understanding the Hand Hygiene Monitoring Landscape Niche / Standalone Can record HH performance at a community or person-specific level Can report across entire hospital, floor, unit, room, shift Utilizes a standalone network and software dashboard Does not integrate with other Hospital Information Systems Ideal for smaller hospitals with limited budgets Can be used as a stepping stone to gather early learnings and explore how to utilize technology to manage HH performance

C ONFIDENTIAL Understanding the Hand Hygiene Monitoring Landscape Niche / Standalone Operates Outside of Hospital Network

C ONFIDENTIAL Understanding the Hand Hygiene Monitoring Landscape Integrated Systems Can integrate with existing hospital infrastructure (Nurse Call, RTLS, Capacity Management, etc.) Can record HH performance at a community or person-specific level Can correlate HH performance to patient / staff workflow and environmental factors Can report across entire hospital, floor, unit, room, shift Provides much greater capability and reporting

C ONFIDENTIAL Understanding the Hand Hygiene Monitoring Landscape Integrated into Hospital Network Integrated Systems RTLS Nurse Call EHR Hospital Operations Security

C ONFIDENTIAL Hand Hygiene Monitoring Technology Community Monitoring Electronic Observation Badge-based Monitoring

C ONFIDENTIAL Hand Hygiene Monitoring Technology By far the most ubiquitous and pervasive technology in Healthcare and growing in use What you need to know: Requires I.T. and/or Bio-Med assistance to connect across hospital network Already deployed for WOWs and medical devices - this technology is already in place Penetrates walls and clothing to track equipment, patients, and to record temperature readings Maximizes ROI of existing I.T. network investments

C ONFIDENTIAL Hand Hygiene Monitoring Technology What you need to know: Embedded in most smart phones and growing in use for medical equipment connectivity – truly a “smart connected” technology Broadly deployed across healthcare; embedded in devices such as blood pressure monitors, temperature measurement, and blood glucose monitors Can be encrypted for secure data and voice transmission 1-2 year battery life for general use Prevalent where the technology's resistance to interference and low- energy use makes it an easy choice

C ONFIDENTIAL Hand Hygiene Monitoring Technology TechnologyCommentsKey Points What you need to know: Works well to isolate objects in a confined space; does not penetrate walls Requires a proprietary network to receive and transmit signals Although easier to support, it does not maximize investment in existing Wi-Fi network Using sound waves to measure the distance, movement and direction of people or objects.

C ONFIDENTIAL Hand Hygiene Monitoring Technology TechnologyCommentsKey Points Using electromagnetic waves to automatically identify and track tags attached to objects. The tags contain electronically stored information. Radio Frequency Identificatio n (RFID) What you need to know: Used to manage mobile medical equipment, improve patient workflow, monitor environmental conditions, and protect patients, staff and visitors from infection or other hazards Active RFID tracks high-value, frequently moved objects; Passive RFID tracks lower cost items at a room or zone level (static) Commonly used within RTLS systems Requires a separate network to send and receive data packets

C ONFIDENTIAL Hand Hygiene Monitoring Technology Using thermal radiation to detect and make visible objects within a line of sight Infrare d(IR) What you need to know: Requires a line-of-sight to detect and transmit Relies on a separate network devices to connect IR signals Commonly used for night vision and thermal detection or objects (heat mapping) Not as prevalent in hand hygiene monitoring solutions; if used, it is generally combined with RF or other technologies

C ONFIDENTIAL Hand Hygiene Monitoring Technology Provide the location and condition of critical resources Asset Tags What you need to know: Needs vary by use case and not all use cases in a solution set are the same Used to automatically identify and track the location of objects or people in real time, usually within a building or other contained area. Wireless

C ONFIDENTIAL Hand Hygiene Monitoring Technology Provide the location and condition of critical resources Electronic Badges Electronic Badges What you need to know: Small, battery powered or re-chargeable device worn by a healthcare worker for role-based or person-specific monitoring (hand hygiene, workflow, security, etc.) May be an obstacle for unionized or hospitals with policies regulating the use of individual tracking devices Badges are developed to use specific wireless technologies for communicating with the system

C ONFIDENTIAL Hand Hygiene Monitoring Technology The backbone of a hand hygiene monitoring system Network & Locating Devices What you need to know: Used to locate an object in a specific location (hallway, room, etc.) Room sensors detect other devices in a room or zone (e.g. badges, dispensers, asset tags) Commonly send data to a gateway device which sends data through the proprietary or hospital network to a processing device (on-site server or cloud-based service)

C ONFIDENTIAL Key Considerations Form a cross-functional team Develop clear requirements Review multiple solutions Understand what you are getting Prepare staff and leadership Develop processes and competencies to support the system Understand the implementation plan Validate for accuracy and capability Build programs to achieve sustainable performance Technology alone will not succeed

C ONFIDENTIAL The Journey of Implementing the Solution Increase hand hygiene performance & decrease HAIs Improve patient experience and safety Consistent and continuous unbiased reporting Workflow optimization Identify high/low hand hygiene performers (individual accountability) Evaluate the impact of interventions over time Integration with existing hospital information systems Determine What Problems Need to be Solved

C ONFIDENTIAL The Journey of Implementing the Solution Secure interface Easy to navigate with intuitive key indicators Displays data in a historic / present format Customizable Ad Hoc Reporting Alerts and Push-reporting Available on multiple devices (PC, iPad, Android) Displays hand hygiene performance across the hospital hierarchy What to Look for in a Dashboard Web Portal Experience Mobile Apps

C ONFIDENTIAL The Journey of Implementing the Solution Robust [secure] Dashboards and ad hoc reporting Frequency of Data Updates - real-time, near real-time, etc. Workflow rules set for each discipline or area Accuracy, reliability, and scalability Battery life and replacement program; badge deployment program Uptime expectation / Service Level Agreement Data Access & Ownership Confirm Solution Capabilities

C ONFIDENTIAL The Journey of Implementing the Solution Hand Hygiene Monitoring vs. Direct Observation – be ready for a potentially difficult conversation Identify where to monitor and why Data -> Information -> Interventions – Have your plan ready New process development and staff competencies Educate staff on proper hand hygiene practices (C-suite to front-line) Determine the level of data capture (individual vs. role) Have a well-rounded skin care program – people, product, programming Preparing for Implementation

C ONFIDENTIAL Selecting a Hand Hygiene Monitoring Solution Validate to build the believability factor 24x7 non-subjective hand hygiene metrics (oh, and lots of data!!!) Hawthorne effect in hand hygiene performance Dealing with high/low performers Staff concerns and issues (e.g. badges, dosing, skin health, HH credit) The overall impact on HAI reduction Clinical support to help interpret the data and manage intervention plans Increased support from EVS and Housekeeping for product replenishment What to Anticipate Post-Installation

C ONFIDENTIAL The Impact of Hand Hygiene Monitoring

C ONFIDENTIAL The Impact of Hand Hygiene Monitoring

C ONFIDENTIAL The Impact of Hand Hygiene Monitoring Hand hygiene rates were increased and sustained when electronic hand hygiene monitoring was combined with complementary hand hygiene improvement strategies. Installing technology without complementary hand hygiene improvement strategies did not improve or sustain hand hygiene rates. Successful outcomes with electronic hand hygiene monitoring require complementary improvement strategies as well as: Executive leadership/Physician commitment and engagement Hand hygiene champion Unit-level leadership engagement Commitment and tenacity

C ONFIDENTIAL The Role of the Infection Preventionist Lead the development of the business case and present to internal KDMs Charter the team who will evaluate and select the solution Lead the gathering of requirements (using a whole systems approach) Select potential solution providers and oversee early evaluations (pilots) Perform system validation and provide final approval toward full implementation Develop policies, educational materials, and training for staff Review and manage contracts and service agreements Receive reports and identify improvement programs to increase and sustain HH performance Identify champions to drive use and promote proper hand hygiene behavior You play a key role in the overall success of a Hand Hygiene Monitoring Solution!

C ONFIDENTIAL Q&A Thank you!