Hand Hygiene Measurement Technology Presenter: Jane Kirk MSN RN CIC Clinical Director Healthcare GOJO Industries, Inc. January 2015

At the end of this presentation you will be able to: LEARNING OBJECTIVES At the end of this presentation you will be able to: Describe 3 barriers to hand hygiene compliance Name 3 technologies to consider for measuring HH Discuss and identify the differences between AMS and RTLS

Hand Hygiene & Healthcare Associated Infections Why is This Important? 1.7M HAI’s are reported each year 99,000 deaths each year, attributable to HAI’s 1 out of every 20 hospitalized patients will contract an HAI Length of Stay (LOS) increases up to 18 days HAI’s cost the U.S. health care system billions of dollars each year CDC cites proper hand hygiene as #1 intervention in fighting HAIs Compliance rates in the US average less than 50% Global research indicates that improvements in hand hygiene activities could potentially reduce HAI rates by up to 50%

Why is hand hygiene compliance so low? Average Compliance is less than 50%, nationally Too busy—high workloads—hands full—multiple distractions HCWs forget—already thinking about next task Inconvenient placement of sinks and dispensers Skin irritation and dryness due to handwashing Not a habit—safety culture doesn’t stress importance of hand hygiene at all levels of organization Inadequate knowledge of hand hygiene guidelines and protocols *2009 Joint Commission Center for Transforming Healthcare

Economics of HAI’s In almost all cases, hospitals did not receive full reimbursement; on average, hospitals statewide were paid approximately 27% of the established charges. The hospital must absorb the additional costs associated with HAI’s, while the HAI’s simultaneously prevent new admissions w/ reimbursable conditions.

Economics of HAI’s Business Case / ROI Focus: Excess cost of HAI’s – Hospital dependent Excessive length of stay (LOS) – lost opportunity cost Define multi-modal strategy and needed resources

Hand Hygiene Improvement = Higher Standard of Care

How is hand hygiene monitored today? Direct observation Consumption modeling Patient Surveys So let’s walk through the current methods of HH monitoring to understand what they are, and the results they provide to infection control professionals for gauging HH compliance. CONFIDENTIAL

Compliance Management Approaches Video Surveillance Person Specific Monitoring Cost Area/Group Monitoring This slide shows the various buckets that all available technology falls into. At the lowest cost / lowest impact is “direct observation” The GOJO SmartLink system resides in the Activity bucket and our RTLS partners reside in the Person specific bucket. Additionally, no matter the technology, GOJO is able to make our TFX and LTX dispensers work with each Observation App’s Direct (manual) Observation Impact

Three Primary Technologies to Consider … Area / Group Monitoring Individual / Role Monitoring Direct Observations Apps

Option #1 – Activity/Group Monitoring Entry/Exit activity Dispenser activity Compliance by location Building, floor, unit, room Automated Reporting – 24/7 Not “Big Brother” “Community” metric / no badges Team based performance Group-level reporting structure Little IT infrastructure required The first technology category to review is Activity-Based Monitoring solutions. With this type of system, (2) metrics are monitored: (1) Area entry / exit … and … (2) Dispensing activity tied to a specific area A key point to consider with this technology, is that it is not intended to eliminate Direct Observation, rather, it is intended to compliment it. This type of system does not indicate “who” is entering or exiting an area or “who” is dispensing, rather it simply logs and displays that “a person” foamed-in and then entered a room (as a example). This type of system, typically does not require IT infrastructure to be operated and typically is set-up as a stand-alone system, again, separate from the hospitals IT infrastructure. Some benefits are of this technology is: Ability to monitor trends and patterns in hand hygiene compliance It provides near real-time metrics It can provide data by location or area and is monitoring 24/7 … when implementing this type of technology, expect your data pool for “monitored” event to exponentially increase. (and last) It does not have person-specific implications, such as the big brother aspect.

Option #2 – RTLS / Individual Monitoring Asset Management Equipment Maintenance Condition Monitoring Patient & Staff Safety Patient Flow Hand Hygiene Fewer purchases, reduced rentals, loss prevention Productivity, quality performance, safety PMs, locating, change in status Spoilage - pharmaceuticals, blood, organs ER wait times, OR / bed scheduling There are 5 Common Use Cases, or Applications within RTLS: And a hospital can implement one or all of the applications, depending on their needs. The goals for this type of system are to improve patient care, reduce costs, and increase the safety of the patient and HCW. Asset Tracking – provides the ability to locate, track, and better manage critical mobile assets for maximum return on investment. It also increases staff efficiency, improves workflow and significantly reduces search and wait times for ordered equipment. Beds, infusion pumps, mobile monitoring devices, and wheelchairs. Equipment Maintenance – Know when devices are due for maintenance, or are showing signs of failure, ensuring you have the right assets, working well, when they are needed. Condition Monitoring – used for critical hospital assets such as blood, tissue, organs, and pharmaceuticals…any variation in temp or humidity is reported immediately to administrative staff Patient & Staff Safety – helping managing patients that are at risk for wandering, alerting staff if they enter areas that are not safe/allowed. Staff duress alerting to inform HCWs when a colleague has been put in a dangerous situation or needs assistance with a patient that could cause them harm. Patient Flow – helps manage patient throughput and productivity by reporting on the movements of a patient from admission to discharge, so hospital staff can create efficiencies in patient flow (such as in emergency departments). Hand Hygiene – the newest Use Case being deployed by RTLS companies is Hand Hygiene. This use case monitors HCW HH practices, and reports their individual, role, or team compliance rates. The goal of the HH use case is to REDUCE HAIs and IMPROVE OUTCOMES. Reduce HAIs, Improve outcomes Improve Patient Care • Reduce Costs • Increase Safety • ROI

Option #2 – RTLS / Individual Monitoring Dispensers Badges Sensory Network How does this technology work relative to hand hygiene compliance? RTLS technology and platforms actually are very similar to an Activity-Based system with two primary differences: 1. Badges (or a similar device such as a wristband or portable device) are used with this type of system in order to monitor an individual (and second) 2. The IT infrastructure needed is much greater in most cases. To briefly explain how this type of system operates, these are the basic steps: The system will record when a person (wearing a device) enters or exits a room Dispensers utilizing some type of communication device will record a person-specific wash-in and wash-out event via the RTLS device being worn on the individual. The RTLS device will then record & communicate the hand hygiene event data to the designated RTLS system. Hand hygiene compliance activity is then presented via a dashboard RTLS Software

ECM – Dashboard & Reporting Customized reporting Provides data by: Location (floor, unit, room) Formulation (soap vs. sanitizer) Date range Shift Device Role Person Data available 24/7

Direct Observation System / APP Pen / Paper Excel / PowerPoint Time Consuming Prone to Errors App for iPad / iPhone & Android Auto-feed into Software Increases standardization of data Significant increased efficiencies Statistically relevant data

Additional Technology … Video monitoring Motion sensors that detect patient room entry and exit Wearable devices that dispense sanitizer & track HCW’s Wrist worn devices that track HH events and techniques Patient tracking devices Virtual wall technology SMART Dispensers

Measurement Alone is not Enough … A Few Methods to Improve Hand Hygiene Compliance: Staff & Patient Education Observation & Feedback Convenient Dispenser Placement Reminders Sanctions & Rewards Leadership Engagement / Priority Avoid Understaffing / Excessive Workload Hand Hygiene = #1 intervention in fighting HAIs You can’t manage what you can’t measure

Q & A