Hand-washing monitoring system at SSM St. Mary's is impossible to ignore

January 15, 2014


An employee badge sniffs hands and turns green when it detects alcohol-based cleanser.

It sounds like a no-brainer. Before doctors, nurses and other health care workers come in contact with a hospital patient, they wash their hands to prevent the transmission of infection.

But more often than patients might think, providers skip the hand washing for one reason or another. According to the Centers for Disease Control and Prevention, close to 100,000 patients in the United States die from hospital acquired infections each year, making it the fourth leading cause of death in America. The problem is widespread; according to the CDC website, "Every day, about 1 in every 20 hospitalized patients has an infection caused by receiving medical care."

How many of these infections are a direct result of unwashed hands is anyone's guess, but experts agree that hand washing is key to reducing the infections. And a new hand hygiene system being tested by SSM St. Mary's Health Center in St. Louis is proving that with technological encouragement and electronic tracking, nearly 100 percent hand hygiene compliance is possible.

"At St. Mary's, we've always had a strong hygiene culture that is around, or at, 90 percent" compliant, said Dr. Morey Gardner, director of the division of infectious disease and infection prevention, and director of internal medicine, at SSM St. Mary's. "But we never seemed to be able to get much past that 90 percent until now."

Even at 90 percent, SSM St. Mary's was way ahead on compliance. A 2009 study by the American Journal of Medical Quality reported hand-washing rates among hospital employees as low as 30 percent. Forgetfulness, lack of time, irritated skin and empty soap dispensers were among some of the excuses cited for not washing.

And until recently, there hasn't been much culpability for not complying or tracking compliance. The industry's standard oversight has been more along the lines of a "secret shopper" approach in which either staff or video cameras observe hand-washing behavior and monitor the results. Compliance data was based on estimates from somewhat limited, and sometimes subjective, observations.

But the incentive to wash — and to monitor — is now much stronger. As part of the Affordable Care Act, hospitals stand to lose Medicare money when patients get preventable infections.

Smell-all, tell-all badge
In April of 2012, SSM St. Mary's began testing a new electronic hand-hygiene system developed by Biovigil Hygiene Technologies based in Ann Arbor, Mich. Patients at the hospital know if their nurses have clean hands because of a badge they wear which changes color and chirps.

This is how it works: When nurses come on duty, they pick up the electronic device, which clips onto their employee badge. The device then communicates with an infrared sensor mounted both inside and outside a patient's room. The device flashes yellow when nurses walk into the room, and it beeps intermittently for 40 seconds to remind them to wash their hands.

Once they wash using an alcohol-based solution, they place their clean hands near the device, which electronically sniffs the alcohol and turns the badge a bright green. If they don't wash within 40 seconds, the device makes a different beeping noise for 35 more seconds before it turns red. Red means a nurse's hands have not been properly sanitized. Meanwhile, all this information is recorded electronically and is available to review immediately.

"Doctors and nurses having clean hands is always something I just assumed happened at a hospital," said Dennis Thompson, 39, a recent heart patient at SSM St. Mary's. "I had no idea that was even an issue." Now that he knows about the risk of health care acquired infections, the beeper-badge system gives him peace of mind, he said. "The last thing anyone wants to worry about as a patient is getting some kind of infection and becoming sicker than you were when you were first admitted."

Green lighting work flow
Theresa Gratton, a registered nurse and certified infection preventionist, who coordinates SSM St. Mary's infection prevention program, said the device has gone through several incarnations to make sure it doesn't impede nurses from doing their jobs efficiently.

"You can't slow down a nurse," said Gratton, explaining that the device has been tweaked several times in the past 18 months to make it more attuned to the nurses' work flow. For example, an early version of the badge only cycled from green to red upon entry or exit, and had unchangeable cycle times. Nurses sought more flexibility to mirror how they worked and traveled between rooms, which led to the addition of the interim yellow reminder cycle.

Today, added Gratton, the system has unlimited flexibility to adapt to different hospital policies and clinical use settings. She says the system currently is being tested in the hospital's 34-bed medical surgery unit and 10-bed cardiovascular intensive care unit. The nursing staff just got the latest version of the system. Gratton said it has been greatly enhanced by incorporating learnings from user feedback and study data. The technology now captures compliance data of soap and water hand washing in addition to the alcohol-based sanitizers. When the nurse washes his/her hands at the sink, the device communicates with the infrared sensor and the badge turns blue for 15 seconds.

Over the next few months, the study will be expanded to include clinical ancillary personnel and hospital-based physicians. The system also will be deployed to a medical and a surgical intensive care unit, a telemetry nursing unit and a dialysis unit. Gratton added that she is eager to study the system in the ward setting of the dialysis unit.

SSM St. Mary's will decide this year whether to further expand the monitoring system.

Gratton also noted that SSM St. Mary's participation in the study is driven by its quest for 100 percent hand hygiene compliance. Biovigil is using SSM St. Mary's as a testing site and not charging the hospital for use of the system.

"Our whole interest is in the quality of the care that our patients receive and in their safety," said Gardner. "That is the fundamental to our mission. When we bring someone with an illness into our hospital our goal is always to make them better. We don't want to give them another disease. Proper hand hygiene is critical to this effort."

Copyright © 2014 by the Catholic Health Association of the United States

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