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

2. 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

3. 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

4. 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%

5. 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
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: /

6. 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?

7. 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

8. 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

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

10. 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

11. 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

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

13. 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

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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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)

24. 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

25. 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

26. 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

27. The Impact of Hand Hygiene Monitoring

28. The Impact of Hand Hygiene Monitoring

29. 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

30. Q&A
Thank you!

31. Appendix

32. 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!

33. 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

34. 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

35. 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

36. 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

37. 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