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Automated Hand-Hygiene Compliance Tech Tackles Hospital-Acquired Infections

Analysis  |  By Scott Mace  
   January 19, 2021

Memorial Healthcare budgets to implement Intelligent Observations' sensor-driven approach systemwide.

As the COVID-19 pandemic rages on, a small but growing number of hospitals are investigating or installing automated technology that promises to reduce hospital-acquired infections through a new internet of things approach to hand hygiene.

One such hospital is Joe DiMaggio Children's Hospital in Hollywood, Florida, which plans to begin piloting technology from Intelligent Observation in the next three months.

The Centers for Disease Control and Prevention lists improving hand hygiene compliance as an optimal way to reduce healthcare-acquired infections in hospital facilities. A 2016 Centers for Disease Control study characterized average compliance with hand hygiene standards at less than 50%. At most hospitals today, compliance with hand hygiene requirements is measured by assigned observers with pen, paper, and clipboards.

The technology alternative uses near-field magnetic induction (NFMI) technology to verify that clinicians are washing or sanitizing their hands the proper amount of time, every time, at appropriate transitions of care. Due to its location accuracy, NFMI is able to do this with a far greater precision than previous technologies that rely upon RFID wireless technology.

The system pairs NFMI-powered sensors with NFMI-powered badges, upgrading badges already typically worn by clinicians. If clinician don't wash or sanitize their hands when approaching a patient to touch them, or after touching them, Intelligent Observation sensors can silently record the fact that hands weren't washed for a sufficient amount of time.

The technology can also provide an auditory signal before the clinician touches the patient or the next patient, to prompt the clinician to wash or sanitize their hands. Implementation of this option is left up to hospital and health system management.

If the clinician does stop for an adequate period of time at a hand-washing station or hand sanitizer dispensers, other Intelligent Observation sensors record that as well to ensure hand hygiene compliance.

The new technology "facilitates something we've been doing manually today," says Jeffrey Sturman, senior vice president and chief information officer of Memorial Healthcare System, which owns the 226-bed Joe DiMaggio Children's and numerous other hospitals in south Florida. "We’re going to be able to see the dividends of this pretty quickly."

In fact, Sturman says, the entire 2000-bed Memorial Healthcare System has budgeted installation of Intelligent Observation throughout the entire system during the next fiscal year, which begins on May 1. Sturman hopes to begin the pilot at Joe DiMaggio in February, March, or April.

Technology Also Enables Data-Driven Contact Tracing

"I'm capturing data in a very specific manner, down to the centimeter or millimeter level, knowing who's been in a room," Sturman says. In fact, not only can the technology determine hand hygiene compliance, but it also enables a more data-driven form of contact tracing for COVID-19, MRSA, or any other infectious disease, he adds.

The Intelligent Observation tech also tackles two huge problems with traditional visual-observation methods of verifying hand hygiene compliance.

The first is that healthcare institutions conduct a bare minimum number of visual observations to comply with regulations. That number amounts to between 1% and 2% of all hand hygiene events in hospitals, says Seth Freedman, CEO of Intelligent Observation.

Freedman says the fact that these data are extrapolated from the small sample means they are not statistically accurate. Intelligent Observation's always-on monitoring of compliance provides, for the first time, a reliable representation of all hand hygiene data, he says.

The second problem with visual observation is the Hawthorne Effect, a well-researched phenomenon that humans do what they are supposed to do when they know they are being watched, but when they are not, they resume their typical behavior.

Sturman says rather than pushing back or resisting the new technology, Memorial Healthcare clinicians are helping to improve the product to adhere to the World Healthcare Organization's "My 5 Moments for Hand Hygiene" protocol.

"Most hospitals in the United States actually don't do this, whereas most hospitals in Europe and Asia do follow these moments through the WHO process," Sturman says.

U.S. hospitals follow the simpler "entry and exit" guidelines of checking that clinicians wash or sanitize their hands before and after touching patients in part because they are easier to visually observe, Freedman says.

Still, some U.S. hospitals, including Memorial Healthcare, are already committed to the WHO protocol, and think Intelligent Observation gives them, for the first time, a way to adhere to the 5 Moments protocol.

"We're proud of it, and we think it's the safest and most clinically effective thing to do," Sturman says.

When Intelligent Observation goes into Joe DiMaggio and other Memorial Healthcare hospitals, the sensor in each room will be placed not in the doorway typical for entry and exit sensing, but instead will be right next to the bed, creating a zone around the bed where the full WHO protocol can be recorded.

The WHO protocol adds three events to simple entry and exit. The three additional events are: performing an aseptic task, body fluid exposure risk, and contact with patient surroundings.

Before adopting Intelligent Observation, Sturman did consult with one of the first U.S. hospitals to adopt it: HCA Healthcare-owned Parkridge Medical Center in Chattanooga, Tennessee.

"Every U.S. hospital we've spoken to has talked about having a transition plan to be able to move from entry and exit [only] to the five moments," Freedman says. "Intelligent Observation gives them a tool to be able to do that."

Like any technology, Intelligent Observation comes with a price tag, but in addition to fully meeting hand hygiene compliance, this technology also can free up scarce nurse resources previously devoted to visual observation of hand hygiene.

"Most healthcare systems right now have a priority to figure out how to get nonessential nursing activities off of nurses' plates," Freedman says.

"The average 250-bed hospital spends about $60,000 to $70,000 a year in [visual observation] costs, and that's approximately what Intelligent Observation costs per year for a 250-bed hospital," Freedman says.

Memorial Healthcare is starting with Joe DiMaggio Children's because of interest by executives to adopt innovative technology there first, Sturman says. This will serve as a jumping-off point for more widespread adoption.

“We’re going to be able to see the dividends of this pretty quickly.”

Scott Mace is a contributing writer for HealthLeaders.


Average clinician compliance with traditional visual methods of hand-hygiene compliance is less than 50%.

New approach uses Near-Field Magnetic Induction for greater accuracy than RFID approaches.

Eliminating cost of existing methods will pay for annual operation of technology.  

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