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Compliance science: Big Brother in a little badge
A high-tech answer to hand hygiene woes
Epidemiologists and computer scientists at the University of Iowa have collaborated to create a wireless electronic badge that monitors hand hygiene compliance. The study was unveiled recently in San Diego at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).
The pilot study uses "Zigbee" technology which is part of a new generation of wireless devices that require little power. Workers wear small, pager-sized badges to monitor their use of hand hygiene dispenser stations prior to entering patient rooms. Researchers placed small beacons inside patient rooms and other designated locations. Each use of the dispenser station is automatically reported by the user's badge, which logs the time and length of use, date, and dispenser ID number. The data from the badges can be automatically offloaded multiple times, which means results are recorded and aggregated without any manual data entry.
Nixes the Hawthorne Effect
The automated monitoring system correctly identified more than 90% of study subjects entering and exiting patient rooms when they remained in the room for 30 seconds.1 When the time in the room is increased to 60 seconds, the monitoring system approaches 100% identification of subjects entering and exiting patient rooms. With human observation there also is the potential for a Hawthorne Effect, meaning workers will only clean their hands when being actively observed. Older automated monitoring technology, called radiofrequency identification (RFID) infrastructure, is available, but can be prohibitively costly and consumes far more power.
"More and more hospitals are attempting to monitor hand hygiene compliance among their workers," Philip Polgreen, MD, an infectious disease physician at the University of Iowa, said at a SHEA press conference. "To date, most of these efforts have involved the direct observation of hand washing by mostly human observers. This is labor-intensive and may not be as accurate as we'd like. Thus, at the University of Iowa, an interdisciplinary team of computer scientists, epidemiologists, and a physician have developed a novel and relatively inexpensive way to monitor whether health care workers have entered or exited a room without using a hand hygiene dispenser, or whether they have used it. This method relies upon wireless technology, and unlike previous efforts, does not require expensive investment in an infrastructure or a network of computers or sensors that have to be built into the walls of a hospital."
The information can be fed back to health care workers very quickly in a way that is informative rather than punitive, he added. "One of the current projects is to de-identify the data at an individual level," Polgreen said. "We can provide this at a unit level and still have a way — much like if you remember back in school there'd be a list of test scores on a wall — that you would know what your score is, and everybody would get an idea of the distribution."
Polgreen points out that more testing in a variety of hospital settings is necessary.