Understanding Electronic Hand Hygiene Monitoring Systems Presented by: Tim Cambier 9/19/16

Agenda Learning Objectives What’s the Problem? How Technology Lives Within Your Hospital Understanding the Hand Hygiene Monitoring Landscape Hand Hygiene Monitoring Technology & Devices Key Considerations in Selecting a Hand Hygiene Monitoring System Q&A

Learning Objectives Understand the importance of proper hand hygiene behavior 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

The Problem: Healthcare Associated Infections (HAI) Improper hand hygiene is one of the primary causes of HAIs, which result in approximately 772,000 infections and 75,000 deaths a year in the United States, and lead to Billions in excess healthcare costs CDC cites proper hand hygiene as the #1 intervention in fighting HAIs Direct observation is time-consuming, biased, and statistically insignificant HCW Hand Hygiene Compliance rates in the US average less than 50%

Addressing the Problem: World Health Organization Multimodal Hand Hygiene Improvement Strategy1 System Change – accessibility of resources and products Training / Education – regular training on the correct procedures Evaluation and feedback – monitoring and reporting performance Reminders in the workplace – reinforcing proper behavior Institutional safety climate – HCW, patients, visitors; awareness Improved hand hygiene compliance among healthcare workers in a 200- bed hospital by as little as 1% would prevent approximately 1 episode of infection due to MRSA and would result in MRSA prevention–associated cost savings of almost $40,000 per year.2 1 WHO | Testing the WHO Guidelines on hand hygiene in health care in eight pilot sites worldwide. (n.d.). Retrieved September 12, 2016, from http://www.who.int/gpsc/country_work/pilot_sites/introduction/en/ 2 Keith L. Cummings, Deverick J. Anderson, and Keith S. Kaye, “Hand Hygiene Noncompliance and the Cost of Hospital‐Acquired Methicillin‐Resistant Staphylococcus Aureus Infection,” Infection Control and Hospital Epidemiology 31, no. 4 (April 2010), doi:10.1086/651096.

How Technology Lives Within Your Hospital Hospital Information Systems Core Networks Security RTLS EHR Nurse Call Hand Hygiene 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?

How Technology Lives Within Your Hospital - Systems 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 Hospital Records Staff Access Patient/Staff Safety Video Monitoring Medication Control Wander Monitoring Security and Surveillance Dispensing Systems Consumable Usage IP Policies Hand Hygiene Compliance

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

Hand Hygiene Management Approaches Video Surveillance Person-Specific Monitoring Cost Area/Group Monitoring Automated Observation Impact

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

Understanding the Hand Hygiene Monitoring Landscape Area / Group Monitoring Tracks ALL HH performance but does not distinguish “who” Can report across entire hospital, floor, unit, room, shift Most often utilizing a standalone network and software dashboard - not integrated with 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

Understanding the Hand Hygiene Monitoring Landscape Area / Group Monitoring Operates Outside of Hospital Network

Understanding the Hand Hygiene Monitoring Landscape Person Specific Monitoring Utilizes electronic badges to collect individual or role-based HH metrics Can integrate with existing hospital infrastructure (Nurse Call, RTLS, Capacity Management, etc.) Can correlate HH performance to patient / staff workflow and other external factors (time in room, proximity to patient, etc.) Can report across entire hospital, floor, unit, room, shift Provides much greater capability and reporting

Understanding the Hand Hygiene Monitoring Landscape Person Specific Monitoring RTLS EHR Security Hospital Operations Nurse Call Integrated into Hospital Network

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

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 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

Hand Hygiene Monitoring Technology Prevalent where the technology's resistance to interference and low- energy use makes it an easy choice What you need to know: Embedded in most smart phones and growing in use for medical equipment connectivity – truly a “smart connected” technology Becoming broadly deployed across healthcare Integrates with Wi-Fi and can be encrypted for secure data and voice transmission 1-2 year battery life for general use

Hand Hygiene Monitoring Technology Using sound waves to measure the distance, movement and direction of people or objects. 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 Technology Comments Key Points

Hand Hygiene Monitoring Technology Radio Frequency Identification (RFID) Using electromagnetic waves to automatically identify and track tags attached to objects. The tags contain electronically stored information. What you need to know: Used to manage mobile medical equipment, improve patient workflow, monitor environmental conditions, and protect patients and staff 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 Technology Comments Key Points

Hand Hygiene Monitoring Technology Infrared(IR) Using thermal radiation to detect and make visible objects within a line of sight 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

Hand Hygiene Monitoring Technology Asset Tags Provide the location and condition of critical resources 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

Hand Hygiene Monitoring Technology Electronic Badges Used to locate and manage staff activities 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

Hand Hygiene Monitoring Technology Network & Locating Devices The backbone of a hand hygiene monitoring system 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)

Internet of Things As you know, digital disruption is occurring everywhere, even in our own industry. It impacts the way in which we communicate with our customers, our internal processes and the products we are developing. Finding we need to change how we work together, processes, products and services are in need of modification –buildings are becoming more Developing connected solutions to solve problems

IoT Application for Hand Hygiene Benefits of connected devices: Can monitor status of devices & consumables Reduces product waste and increases sustainability profile Improves inventory management Increase labor efficiency enabling focus Supports accountability of services provided Increases accuracy in bid planning

Technology alone will not succeed Key Considerations Form a cross-functional team Develop clear requirements Review multiple solutions Understand what you are getting Prepare staff and leadership Set achievable goals 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

The Impact of Hand Hygiene Monitoring

The Impact of Hand Hygiene Monitoring

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

Q&A Thank you!

Appendix

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!

The Journey of Implementing the Solution Determine What Problems Need to be Solved Increase hand hygiene performance & decrease HAIs Improve patient experience and safety Consistent and continuous unbiased reporting Badges or Community based performance? Evaluate the impact of interventions over time Integration with existing hospital information systems

The Journey of Implementing the Solution What to Look for in a Dashboard 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) Web Portal Experience Mobile Apps

The Journey of Implementing the Solution Confirm Solution Capabilities 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 Agreements

The Journey of Implementing the Solution Preparing for Implementation 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) Have a well-rounded skin care program – people, product, programming

Selecting a Hand Hygiene Monitoring Solution What to Anticipate Post-Installation 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