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

2. 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

5. 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%

6. 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

7. 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.

8. 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

9. Hand Hygiene Improvement = Higher Standard of Care

10. 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

11. 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

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

13. 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.

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Q & A