Technology Offers Real-Time Monitoring of Hand Washing

Washing hands is a key component to preventing healthcare-acquired infections and improving patient safety. Yet, knowing which staff members are more compliant with hand washing policies is challenging at best for supervisors and senior leaders. Organizations often rely on observational studies to track and monitor hand washing, but if staff members know that they are being watched, they'll probably alter their typical behavior and wash hands more frequently.

I'm not suggesting that staff members are intentionally foregoing hand washing procedures, but given the pace of healthcare settings, it's an easy thing for clinicians to forget to do as frequently as they should. Soon, however, healthcare executives will have a new tool to track hand washing in their organizations and staff members will have a subtle reminder to wash hands if they forgot.

A new device, called HyGreen, is being developed at the University of Florida that can detect whether employees have washed their hands by "smelling" for alcohol, which nearly every hygiene soap product contains.

Here's how it works: Healthcare workers wear a badge with a unique identifier that sends out a signal about every three seconds. After employees wash hands or use waterless disinfectant products, they place their hands under a sensor, which flashes a green light when it detects alcohol. The detector then sends a signal back to the badge and a green light is activated. Staff members have 60 to 90 seconds to get within range of a device located above the patient's bedcurrently set at eight feet. Their badge sends out a signal denoting who the person is and whether they are clean. If too much time has passed or staff members forgot to wash their hands, the bed monitor sends out a signal that vibrates the staff member's badge as a reminder to wash hands. In addition, all of the data is sent over a wireless network to a central computer in real time that supervisors and senior leaders can evaluate.

HyGreen is currently being tested in the neuro-intensive care unit at Shands HealthCare at the University of Florida, and developers hope to have a commercial product available by the third quarter of 2009 or the first quarter of 2010, according to Richard J. Melker, MD, PhD, who is one of the developers of the technology and the chief technology officer of Xhale Inc.

This technology probably can't come soon enough for healthcare executives given the Centers for Medicare & Medicaid Services policy that it won't pay for certain never events, which are predominately infection related.

"We believe that if our system is deployed and we improve hand washing adherence by 20%, the system will cost far less than what organizations will lose in reimbursements," says Melker, who is also an employee at the College of Medicine at the University of Florida.

So what do clinicians think about the technology? Aside from a little concern about having to wear yet another badge, nurses have been receptive to it, says Richard Reed, nurse manager at Shands neuro-intensive care unit. Anything that healthcare clinicians can do to prevent infection will be positively received, adds Jeanette Hester, the clinical coordinator for Shands neuro-intensive care unit. "Direct healthcare providers want to do the right thing, even if that means they have to wear a bulky badge," says Hester.

The technology does provide healthcare organizations the flexibility to set the time requirement and the range of the sensors to meet the workflow patterns of individual care settings. Shands determined that eight feet still allowed nurses who were not doing direct patient care to peek and check monitors without being buzzed, while at the same time ensuring that any clinician caring for the patient and potentially touching bed rails or equipment had washed hands. The 90 second window was set to ensure that caregivers wouldn't forget to rewash hands if they were interrupted by a page and talked on the phone or left the room after initially washing hands. "A lot of times we are doing things on the fly, and it has increased awareness," says Reed.

"The nice part was that our numbers were better than when we had done observational studies," says Hester, adding that the bigger denominator showed staff members were more compliant that the health system originally thought. "It actually benefited clinicians to get the data back," she says.